Determination of public health importance of hypertension risk factors towards precision prevention in South Africa: A Delphi study protocol

Precision prevention requires stratification of risk factors based on public health relevance and subsequent prioritization of intervention targets. A compendium of public health relevant hypertension risk factors in South Africa presented according to their relative public health relevance is an invaluable asset to advancing precision prevention. Objective To determine the public health importance of hypertension risk factors in South African Methods This qualitative study uses a Delphi technique to assess public health importance of hypertension risk factors in South Africa. Risk factors and corresponding relative risk estimates will be sampled from an ongoing systematic review of hypertension risk factors in sub-Saharan Africa. Indices including pooled relative risk, nature of risk factor (prevalence, severity and modifiability), cost of determining and addressing risk factor, and intervention implications constitute the survey items. Two rounds of online surveys will be administered via Qualtrics platform. Participants include experts with minimum ten years experience in hypertension hospice care or cardiovascular disease research in South Africa. Each survey item will be rated using a four-point Likert scale (irrelevant; somewhat irrelevant; somewhat relevant; relevant). Experts will receive email invitations with questionnaire link and login details. Two reminder emails will be sent per round. Anonymity will be ensured through use of random numbers and codes for completed surveys. Percentages and median will evaluate agreement on Likert scales, while variances and interquartile ranges (IQRs) indicate consensus (a low variance and IQR ≤1 suggest high consensus). Comments and recommendations will be analyzed using inductive thematic analysis. Discussion Community-wide prevention requires precision, utilizing relevant individual and population-specific risk factors. Therefore, beyond statistical significance, assessing public health relevance of hypertension risk factors is essential to advancing the implementation of cost-effective interventions in South Africa. The findings will guide the design of community-wide and sustainable biobehavioral strategy, particularly in selecting intervention targets.