Evaluation of a syndemic care model for rheumatic and musculoskeletal diseases in Mayan-Indigenous communities of Mexico
Evaluation of a syndemic care model for rheumatic and musculoskeletal diseases in Mayan-Indigenous communities of Mexico
Rheumatic and musculoskeletal diseases (RMDs) are among the leading causes of disability worldwide. Their impact is particularly severe in Indigenous communities, where limited access to healthcare, poverty, and other chronic conditions often reinforce one another and contribute to poorer health outcomes. This thesis of Emilio Motte Garcia explored these complex interactions through a syndemic perspective and evaluated a Syndemic Care Model (SCM) developed in partnership with Mayan-Yucatecan Indigenous communities in rural Mexico using a Community-Based Participatory Research (CBPR) approach.
Rather than focusing solely on disease, this research recognized that health is shaped by the interaction of biological, social, and structural factors. Working closely with community members, healthcare professionals, and local stakeholders, the project co-designed and implemented an intervention that responded to locally identified needs and priorities. A comprehensive assessment of the syndemic burden revealed how RMDs interact with chronic diseases, disability, and social disadvantage, highlighting the importance of addressing these conditions together rather than separately. The intervention was then evaluated using a mixed-methods approach, demonstrating meaningful improvements in pain, physical function, quality of life, access to healthcare, and participants' experiences of care. An economic evaluation further showed that these benefits were achieved at a relatively low additional cost, suggesting that the model represents a cost-effective use of healthcare resources.
Overall, this thesis shows that combining syndemic theory with community-based participatory research can lead to culturally appropriate and sustainable healthcare solutions. The findings support a move towards more integrated, community-centered models of care that strengthen local capacity, reduce health inequalities, and provide a practical framework for improving the management of chronic diseases in Indigenous and other underserved populations.