Background

The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease [1, 2]. According to Word Health Organization (WHO) it is estimated that NCDs cause 40 million deaths annually out of which 80% are due to cardiovascular disease, chronic obstructive pulmonary disease, diabetes mellitus and cancers [2, 3]. The prevalence of NCDs such as cardiovascular disease and diabetes mellitus is particularly high in the Gulf Cooperation Council countries. This includes Qatar which has a significantly high prevalence of NCDs with early on set [4]. The country has one of the highest prevalence of diabetes worldwide and a high proportion of people visiting NCD clinics in primary care settings have diabetes [5, 6].

It is important to acknowledge that there are modifiable and non-modifiable risk factors associated with NCDs which can serve as important indicators for disease surveillance, mapping and projecting future trends and devising treatment and preventive strategies [7, 8]. The commonly known non-modifiable risk factors include genetic predisposition, family history age, gender, and socio-economic status [9]. Whereas the modifiable behavioral risk factors which are also known as lifestyle risk factors mainly encompass diet, physical inactivity, obesity, tobacco use, excessive alcohol consumption, psychosocial factors [10, 11]. Moreover, there are modifiable physiological risk factors (which are also termed as metabolic risk factors) which entail hypertension, dyslipidemia, hyperglycemia, and chronic kidney disease [12–14]. Furthermore, evidence suggests that the wider determinants of health such as socio-economic, cultural, political, and environmental determinants, including population aging, globalization, urbanization, and the accompanied nutrition transition has also significantly contributed towards the recent rise in NCDs globally [9].

The WHO’s proposed a model of primary health care (PHC) after the ‘health for all’ initiative [15]. The concept is based on a multi-sectoral approach and aims to deliver comprehensive care which is well suited in addressing NCDs and its prevention [16–18]. Primary health care over the last few decades has established itself as the cornerstone for building a strong healthcare system that ensures better health outcomes, lower costs, and enables greater equity in health. In its true essence it must cater comprehensive and people-centered healthcare tailored to meet the specific needs of the communities and populations [15]. This should consider individuals of all age groups, ethnicities, and cultural backgrounds. Moreover, the model should ideally incorporate and coordinate health promotion, apply principles of preventive medicine, promote acute and chronic care management activities with the prime objective to deliver equitable access and safe high-quality care. Hence, strengthening primary health care to improve health outcomes and reduce the prevalence of NCDs is essential [14–16]. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar’s publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol.

Methods

Participant recruitment

The target sample of 60,000 individuals will randomly be extracted from PHCC’s electronic medical records system with their health record number, name, age, gender, nationality and mobile phone number–See Fig 1. Participants will be sent Short Message Service (SMS) messages on their mobile phones inviting them to express their interest to participate in the study via an online form. Individuals expressing interest will be contacted to schedule an appointment at a health centre.

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Fig 1. HEALTHSIGHT study patient flow.

https://doi.org/10.1371/journal.pone.0304160.g001

Analytical plan

Prevalence rates with 95% confidence interval (CI) for socioeconomic, behavioral, and metabolic health risk factors and report them stratified by age, gender, nationality, health centre and area of residence with 95% CI. In addition, prevalence of NCDs and health service utilization data will be described stratified by age, gender, nationality, health centre and area of residence using frequencies and percentages. Chi-square test of independence will be used to assess the statistical significance of associations between risk factors, health status and resource utilization with sociodemographic factors.

A logic model of the protocol is presented in Fig 2.

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Fig 2. HEALTHSIGHT logic model.

https://doi.org/10.1371/journal.pone.0304160.g002

Discussion

Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar’s primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar.

The findings of the study will help identify the potential risk factors (modifiable) contributing to the NCDs and predict incidence of new cases which will be substantiated by recording the metabolic risk factors. These indicators can also aid in mapping and projecting future trends of the NCDs. Moreover, Qatar has a diverse expatriate population with local Qatari’s constituting of approximately 12% of the total population. The study will help identify the frequency of the health services utilized by the patients accessing the various health centers. This information is vital in prioritization of the health services which are more inclined towards the needs of the patients promoting a patient centered approach.

WHO is a strong advocate of surveillance of ongoing NCDs and the associated risk factors. This protocol is in accordance with the recommendations of the WHO and moreover aims to project future trajectories and disease patterns which will aid in devising mitigation and preventive strategies within a well-established primary health care system of Qatar. Similarly, a study was conducted in 7 provinces of Nepal to assess the distribution and determinants of NCDs utilizing a WHO recommended STEPS survey(8). The surveillance data reported a significant proportion of Nepalese population exposed to different risk factors associated with NCDs. Our study is prospective longitudinal study, and we aim to repeat the study every three years which will significantly contribute towards the monitoring of specific NCD prevention and control interventions and planning of health services throughout the primary health centers (constituting the Primary Healthcare Cooperation) in Qatar.

Some of the limitations of the study include that the participants will be invited to participate in the study by short messaging service through mobile phones. Similar studies have reported to collected epidemiological data pertaining to NCDs by conducting national surveys. It may be a potential barrier as there is a risk that patients with low literacy levels may not fully comprehend the information provided through the text message and there may be low response rate. However, the study ensures that the participants make informed decision of participating in the study and the recruitment process will also be facilitated by the healthcare staff working in the different healthcare centers. The key strength of the study is that it’s the first of its kind in the country that aims to capture rich epidemiological data which will help identify the potential risk factors (modifiable) contributing to the prevalence of NCDs and predict incidence of new cases and map and project future trends of the NCDs in the country among the different sub-groups of population. Majority of similar studies to date are based on a non-random sample, focus on specific population groups making it difficult to generalise findings or resource intensive. Generally, healthcare systems invest significant resources in conducting NCD surveillance studies. The proposed protocol provides an example of a robust nationwide study that can be undertaken in a short duration using limited resource. This will be useful for healthcare systems seeking to e undertaken such studies in similar settings and can be repeated more frequently to provide recent information to support public health decision making.