Barriers to non-communicable disease care among Syrian Refugees in Lebanon: a socio-ecologic perspective Open Access
Goodlett, Tyler (Spring 2024)
Abstract
Background:
Non-communicable diseases (NCDs) pose a significant global health challenge, with over 41 million deaths annually, primarily affecting low- and middle-income countries (LMICs). NCDs require consistent access to medications and healthcare for effective management. Humanitarian emergencies exacerbate these challenges, with a lack of standardized guidelines for NCD care. Syrian refugees, experiencing a rapid epidemiologic transition pre-displacement, face vulnerabilities in accessing healthcare and essential services. Lebanon, grappling with economic, political, and COVID-19 disruptions, hosts a significant Syrian population, further straining its healthcare system. Understanding barriers to NCD care within Lebanon's public and private healthcare sectors is imperative for addressing the needs of Syrian refugees and mitigating the impact of this humanitarian emergency.
Methods:
Our objective was to better understand how the socio-ecological context informs the provision of NCD care and services through a refined model developed using a modified grounded theory approach. Key-informant interviews were conducted with representatives, healthcare managers, and healthcare providers involved in NCD care for Syrian refugees across governmental, non-governmental, and intergovernmental organizations in Lebanon. Recruitment was leveraged through creating an organizational contact list and through snowball sampling of organizations.
Results:
Among the 10 interviews, three core spheres were observed: refugee, policy, and service delivery. As spheres overlapped, seven themes emerged: governance, infrastructure, human resources, fear, accessibility, fragmentation, and cost. Fear, characterized by subthemes like fear of government and lack of trust, arose within the intersection of policy and refugee spheres. Accessibility and fragmentation emerged between the health system and refugee spheres, while cost intersected all spheres.
Conclusion/Discussion:
Our work revealed a nuanced understanding of barriers to NCD care through a refined model that offsets major limitations in existing health system frameworks. Current frameworks do not sufficiently address socio-ecological contexts and fail to adequately recognize the interconnectedness of components in a health system. This was illustrated by fear being identified as a barrier in our analysis. The comprehensive and interconnected model for barriers to NCD care that our work offers could serve as a guide for tailoring programs, interventions, and implementation research aiming at strengthening NCD care delivery among refugee and displaced populations in Lebanon and other settings.
Table of Contents
Chapter 1: Introduction 1
Background and Rationale 1
Problem Statement 3
Purpose 4
Research Question 4
Significance Statement 4
Chapter 2: Literature Review 6
Overview of Non-Communicable Diseases 6
Burden of NCDs in the MENA Region 7
Barriers to NCD Care 10
Chapter 3: Manuscript 21
Abstract 21
Introduction 22
Methodology 25
Results 30
Discussion 47
References 52
Figure 1: Proto-conceptual model for the status of non-communicable disease care and barriers to it among Syrian refugees in Lebanon 54
Figure 2: Refined model for barriers to non-communicable disease care among Syrian refugees in Lebanon 55
Chapter 4: Conclusions and Recommendations 56
Introduction 56
Public Health Implications 56
Recommendations 60
References 63
Appendix 68
In-depth Interview Guide for Health Care Providers 68
In-depth Interview Guide for Organization Representatives 74
About this Master's Thesis
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