Abstract
BackgroundPrevalence of non-communicable diseases has been increasing at a greater pace in developing countries and, in particular, the South Asia region. Various behavioral, social and environmental factors present in this region perpetuate common metabolic risk factors of non-communicable diseases. This study will identify social determinants of common metabolic risk factors of major non-communicable diseases in the context of the South Asian region and map their causal pathway.MethodsA systematic review of selected articles will be carried out following Cochrane guidelines. Review will be guided by Social Determinants of Health Framework developed by the World Health Organization to extract social determinants of metabolic risk factors of non-communicable diseases from studies. A distinct search strategy will be applied using key words to screen relevant studies from online databases. Primary and grey literature published from the year 2000 to 2016 and studies with discussion on proximal and distal determinants of non-communicable risk factors among adults of the South Asia region will be selected. They will be further checked for quality, and a matrix illustrating contents of selected articles will be developed. Thematic content analysis will be done to trace social determinants and their interaction with metabolic risk factors. Findings will be illustrated in causal loop diagrams with social determinants of risk factors along with their interaction (feedback mechanism).DiscussionThe review will describe the interplay of social determinants of common NCD metabolic risk factors in the form of causal loop diagram. Findings will be structured in two parts: the first part will explain the linkage between proximal determinants with the metabolic risk factors and the second part will describe the linkage among the risk factors, proximal determinants and distal determinants. Evidences across different regions will be discussed to compare and validate and/or contrast the findings. Possible bias and limitations of this study will also be discussed.Systematic review registrationPROSPERO CRD42017067212
Highlights
Prevalence of non-communicable diseases has been increasing at a greater pace in developing countries and, in particular, the South Asia region
Changing individuals’ behavior is not adequate in itself without addressing underlying the social, economic, environmental and cultural factors collectively known as social determinants of health (SDH) [12]
We will use thematic content analysis to identify social determinants of non-communicable diseases (NCDs) risk factors and map the causal pathways leading to major NCDs in the South Asia region using the World Health Organization (WHO) framework described earlier
Summary
The systematic review will be conducted following the Cochrane guidelines [19]. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols. Inclusion criteria Inclusion criteria for selection of studies and grey literature will be as follows: (a) primary research and grey literature published between 2000 and 2016, (b) studies among an adult population aged 20–65 from South Asian region (Nepal, India, Bangladesh, Pakistan, Sri Lanka, Bhutan, Maldives, Afghanistan) and (c) studies and literature that have generated empirical evidences on proximal and/or distal determinants of the selected NCD risk factors Both published and unpublished, grey and peer reviewed, and qualitative and quantitative studies will be included. Coding and thematic analysis about the possible causal linkage among determinants based on the results and discussion of the article relationships operating among variables giving rise to a specific situation. The causal loop diagram will be built using the “Vensim”, a freely available software program for developing system models [27]
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