Experiences of Communities with Lebanon's Model of Care for Non-Communicable Diseases (NCD): A Cross-Sectional Household Survey from Greater Beirut (preprint)

ABSTRACT

Introduction: Health systems in fragile settings face multiple challenges in the implementation of responsive Non-Communicable Disease (NCD) care models. Models based on comprehensive person-centred primary care approaches can improve health system responsiveness and trust in healthcare. In Lebanon, NCDs dominate the health profile, but the health system is fragmented with evidence suggesting varied experiences with the care model. This study aims to identify people's perceptions of the Lebanese care model for NCDs and trust in the health system among others, and test association between them. Methods: This study is a household survey using multistage random sampling and targeting adult community members (both Syrian and Lebanese) living with NCDs in Greater Beirut. Three main outcomes (barriers to care seeking, perceptions of the care model and trust in healthcare) were assessed including by multiple linear regressions. Results: A total of 941 respondents participated in this study. Reported NCDs were hypertension (51.3%) and diabetes (34.5%), followed by chronic respiratory conditions (21.9%) and other cardiovascular diseases (20.0%). Communities reported seeking care from different sources. While 78% of Lebanese participants had visited private clinics at least once within the 6 months preceding the survey, 56% of Syrian refugees had done so. Determinants of access to care were health coverage, gender, and employment among Lebanese, and socio-economic status among Syrian refugees. Lebanese community members had more positive perceptions of the care model compared to Syrian refugees and determinants included socio-demographic characteristics and the type of providers. Trust in the health system was higher among Syrian compared to Lebanese participants and was significantly influenced by the care model score and barriers to care seeking. Conclusion: Our study generated evidence about the experience of people living with NCDs with Lebanon's care model, and can inform service delivery reforms towards a more inclusive person-centred approach.