{
  "abstract": "Background Indigenous Mayan-Yucatecan communities in Mexico have a high prevalence of chronic non-communicable diseases (NCDs) such as diabetes, hypertension, obesity and rheumatic diseases (RMDs). According to the syndemic theory, these diseases combined with social, economic and cultural factors affect the quality of life. The aim of this protocol is to describe the methodological process to create, implement and evaluate a Syndemic-Based Care Model (SCM), using a Community Based-Participatory Research (CBPR) strategy in three Mayan-Yucatecan communities.Methods and analysis This is a convergent mixed-methods protocol. The quantitative component is a before-after study, and the qualitative component is an ethnographic study. The intervention will be a SCM co-constructed with Mayan communities based on their particular needs and aiming for reduction of the negative impact of NCD/RMD through a multidisciplinary approach. We will follow four phases of the CBPR: (1) situational analysis, through community censuses and semistructured interviews to understand the prevalence of NCDs and the syndemics in these communities; (2) co-construction of the elements of a SCM based on the health priorities identified by researchers, community members and healthcare workers; (3) implementation of this SCM and (4) evaluation of the SCM through (1) statistical analyses involving the construction of a syndemic index through stepwise logistic regression of the normalised and standardised key clinical, social and economic variables; interval and ratio variables will be normalised by their z-score and categorical variables will be one-hot encoded; similarity and social networks analysis with clustering to identify syndemic subpopulations; and cost-effectiveness and cost-utility analyses using Markov modelling and (2) narrative and thematic qualitative analysis of the SCM’s implementation and impact on community members’ health, function and quality of life.Ethics and dissemination Research ethics boards of participant institutions approved this research protocol. This project will be presented to municipal authorities, community meetings and community leaders for observation and acceptance. For people who wish to participate, informed consent will be provided written and verbally in Spanish or Mayan-Yucatecan according to the participant preferences, and it can be signed by either autograph or fingerprint. The results of this research will be disseminated to various groups: (a) local and regional authorities of the Mexican health system and municipal authorities; (b) the participating communities will be informed in an assembly of the results and (c) academic dissemination will be done through publications in public science journals and institutional press releases and will also be presented at national and international congresses or symposia.",
  "authors": [
    {
      "affiliations": [
        "Plan de Estudios Combinados en Medicina (PECEM), National Autonomous University of Mexico, Ciudad de Mexico, Mexico",
        "Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands"
      ],
      "name": "Emilio Motte-García"
    },
    {
      "affiliations": [
        "Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico"
      ],
      "name": "Cinthya Cadena-Trejo"
    },
    {
      "affiliations": [
        "Plan de Estudios Combinados en Medicina (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico"
      ],
      "name": "María Fernanda Ramírez-Flores"
    },
    {
      "affiliations": [
        "Instituto de Ciencias Aplicadas y Tecnología, Instituto de Ciencias Aplicadas y Tecnología, Universidad Nacional Autónoma de México (ICAT-UNAM), Mexico City, Mexico"
      ],
      "name": "Alfonso Gastelum Strozzi"
    },
    {
      "affiliations": [
        "University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"
      ],
      "name": "Adalberto Loyola-Sanchez"
    },
    {
      "affiliations": [
        "Facultad de Enfermería y Obstetricia, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico"
      ],
      "name": "María Victoria Fernandez-Garcia"
    },
    {
      "affiliations": [
        "Universidad Marista de Mérida Periférico Norte Tablaje Catastral, Mérida, Yucatán, Mexico"
      ],
      "name": "Karen G Castillo-Hernandez"
    },
    {
      "affiliations": [
        "Community leader, Community of Chankom, Chankom, Yucatán, Mexico"
      ],
      "name": "Kenia Nayrobi López-Herrera"
    },
    {
      "affiliations": [
        "Health Technology Assessment, Department of Epidemiology, Groningen, The Netherlands"
      ],
      "name": "Maarten M H Lahr"
    },
    {
      "affiliations": [
        "Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"
      ],
      "name": "Erik Buskens"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Mexico"
      ],
      "name": "Ingris Pelaez-Ballestas"
    }
  ],
  "title": "Reducing syndemics of non-communicable chronic diseases in Mayan Indigenous population through community-based participatory research: a mixed-methods study protocol",
  "uid": "5ff11f0b-f0e3-5569-bfe6-0931da0fba45"
}