A Delphi protocol for determining public health relevance of hypertension risk factors towards precision prevention in South Africa

Precision prevention calls for stratifying risk factors by public-health relevance and prioritizing intervention targets accordingly. A ranked compendium of hypertension risk factors in South Africa would be a valuable tool for advancing precision prevention efforts nationwide. The study aims to determine the public health relevance of hypertension risk factors in South Africa using a Delphi technique. This study uses a Delphi method to judge the public-health relevance of hypertension risk factors in South Africa. Survey items cover pooled relative risk, prevalence, severity, modifiability, costs of identifying and addressing each factor, and expected population impact. Risk factors and effect estimates will be drawn from an ongoing systematic review of hypertension determinants in sub-Saharan Africa. Experts with at least ten years of experience in hypertension care or cardiovascular research in South Africa will be invited. Two online rounds will be conducted in Qualtrics, where participants will rate each factor on a four-point Likert scale. Responses will remain anonymous through coded identifiers. Agreement will be summarised using percentages and medians, and consensus will be assessed through variance and interquartile range, with an IQR of one or less indicating strong agreement. Logistic-regression marginal effects will examine variables associated with expert ratings. Open-ended comments will be reviewed using inductive thematic analysis to capture reasoning and recommendations for the national hypertension-prevention agenda. The findings support reduction in hypertension prevalence by identifying risk factors of high public health relevance, providing a basis for prioritisation of intervention targets and advancing precision prevention in South Africa.