Task shifting to frontline community health workers for improved Diabetes care in low-resource settings in India : A phase II Non-randomized controlled clinical trial

Acknowledgments: We are indebted to the our research team who worked passionately to complete the study, health workers who were willing to function as patient navigators to improve diabetes management, and to all the participants who responded to our screening invitations and structured care Funding: We acknowledge the funding received from Friends of Vellore, UK and NHS Grampian Endowment fund, University of Aberdeen- Approval Number: EA0852Peer reviewedPublisher PD

The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma.

IntroductionUnderstanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process.MethodsUsing a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level.ResultsProject teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process.ConclusionsContext is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes