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Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study

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journal contribution
posted on 12.05.2022, 00:24 authored by A Ramani-Chander, R Joshi, J van Olmen, E Wouters, P Delobelle, R Vedanthan, JJ Miranda, Brian OldenburgBrian Oldenburg, S Sherwood, LB Rawal, RJ Mash, VE Irazola, M Martens, M Lazo-Porras, H Liu, G Agarwal, G Waqa, MS Marcolino, ME Esandi, ALP Ribeiro, A Probandari, F González-Salazar, A Shrestha, S Sujarwoto, N Levitt, M Paredes, T Sugishita, M Batal, Y Li, H Haghparast-Bidgoli, V Naanyu, FJ He, P Zhang, SG Mfinanga, JW De Neve, M Daivadanam, K Siddiqi, P Geldsetzer, K Klipstein-Grobusch, MD Huffman, J Webster, D Ojji, A Beratarrechea, M Tian, M Postma, MO Owolabi, J Birungi, L Antonietti, Z Ortiz, A Patel, D Peiris, D Schouw, J Koot, K Nakamura, G Tampubolon, AG Thrift
INTRODUCTION: There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS: We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION: The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Funding

RJ is supported by the Australian National Heart Foundation (102059) and a UNSW Scientia Fellowship.

History

Publication Date

18/04/2022

Journal

BMJ Open

Volume

12

Issue

4

Article Number

e053122

Pagination

10p.

Publisher

BMJ Publishing Group

ISSN

2044-6055

Rights Statement

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.