WHO STEPSwise Risk Model for Noncommunicable Disease Control in Coastal Communities of Makassar City

Abstract

Noncommunicable Diseases (NCDs) account for approximately 71% of all deaths worldwide and pose particular challenges for coastal communities owing to geographical isolation, limited healthcare access, and unique socioeconomic characteristics. This study aimed to develop a comprehensive NCD risk model using the WHO STEPSwise framework in coastal areas of Makassar, Indonesia. A cross-sectional study was conducted from June to July 2025, involving 138 adults aged ≥ 18 years from five coastal sub-districts. The WHO STEPSwise approach was applied in three steps: Step 1 (ques-tionnaire on demographic and behavioral risk factors), Step 2 (physical measurements), and Step 3 (biochemical measurements). Data were analyzed using Structural Equation Modeling (SEM) with R software and the lavaan package. The resulting model demon-strated excellent structural validity, with fit indices of CFI = 0.994, TLI = 0.993, RMSEA = 0.039, and SRMR = 0.016, explaining 61.4% of the variance in NCD control outcomes (R2 = 0.614). Among the com-ponents, biochemical parameters (Step 3) were the strongest pre-dictors (β = 0.333, p < 0.001), followed by physiological conditions (Step 2) (β = 0.309, p < 0.001), and behavioral factors (Step 1) (β = 0.261, p < 0.001). A significant indirect effect of behavioral factors on biochemical factors through physiological improvement was also observed (β = 0.558, p < 0.001). The proposed model reflects a valid and contextually relevant framework for NCD control in coastal communities and may serve as a basis for planning NCD prevention strategies for other vulnerable populations.

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