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.

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

Behind the gold medals

'The culture of silence that engulfs most Fijian students needs to be discouraged, and those who have failed must remember that there is nothing wrong with failure— but there is plenty wrong in giving up.'</jats:p

Behind the gold medals: PROFILES IN THE MEDIA: Wainikiti Waqa-Bogidrau

'The culture of silence that engulfs most Fijian students needs to be discouraged, and those who have failed must remember that there is nothing wrong with failure— but there is plenty wrong in giving up.

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

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.Fil: Ramani Chander, Anusha. Monash University; AustraliaFil: Joshi, Rohina. George Institute For Global Health; India. University of New South Wales; AustraliaFil: Van Olmen, Josefien. Universiteit Antwerp; BélgicaFil: Wouters, Edwin. Universiteit Antwerp; BélgicaFil: Delobelle, Peter. University of Cape Town; Sudáfrica. Vrije Unviversiteit Brussel; BélgicaFil: Vedanthan, Rajesh. Nyu Grossman School Of Medicine; Estados UnidosFil: Miranda, J Jaime. Universidad Peruana Cayetano Heredia; Perú. University of New South Wales; AustraliaFil: Oldenburg, Brian. La Trobe University; AustraliaFil: Sherwood, Stephen. University of Agriculture Wageningen; Países BajosFil: Rawal, Lal B.. Central Queensland University; AustraliaFil: Mash, Robert James. Stellenbosch University; SudáfricaFil: Irazola, Vilma Edith. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Martens, Monika. Universiteit Antwerp; Bélgica. Institute of Tropical Medicine; BélgicaFil: Lazo Porras, Maria. Universidad Peruana Cayetano Heredia; PerúFil: Liu, Hueiming. University of New South Wales; AustraliaFil: Agarwal, Gina. McMaster University; CanadáFil: Waqa, Gade. Fiji National University; FiyiFil: Soriano Marcolino, Milena. Universidade Federal de Minas Gerais; BrasilFil: Esandi, Maria Eugenia. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Pinho Ribeiro, Antonio Luiz. Universidade Federal de Minas Gerais; BrasilFil: Probandari, Ari. Universitas Sebalas Maret; IndonesiaFil: González Salazar, Francisco. Universidad de Monterrey.; MéxicoFil: Shrestha, Abha. Kathmandu University School of Medical Sciences; Nepal. Dhulikhel Hospital; NepalFil: Sujarwoto, Sujarwoto. University of Brawijaya; IndonesiaFil: Levitt, Naomi. University of Cape Town; SudáfricaFil: Paredes, Myriam. Facultad Latinoamericana de Ciencias Sociales; EcuadorFil: Sugishita, Tomohiko. Tokyo Women's Medical University; JapónFil: Batal, Malek. University of Montreal; Canadá. Centre for Public Health Research; CanadáFil: Li, Yuan. The George Institute for Global Health at Peking University Health Science Centre; China. University of New South Wales; AustraliaFil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Challenges and enablers for scaling up interventions targeting non-communicable diseases: a qualitative study applying the Consolidated Framework for Implementation Research to 19 research projects worldwide

Introduction Scaling up interventions targeting non-communicable diseases (NCDs) is a global health priority, and implementation research can contribute to that effort. In 2019, the Global Alliance for Chronic Diseases funded 27 implementation research studies to improve evidence for scaling up interventions targeting prevention and/or control of hypertension and/or diabetes in low-resource settings. We examined these studies to improve the understanding of the implementation factors, including challenges and facilitators, that influence the early implementation phase of scale-up research projects targeting NCDs.Methods This qualitative study was undertaken between August 2020 and July 2021. 43 semi-structured interviews were conducted with project investigators, implementers and policymakers, across 19 diverse scale-up projects, being implemented in 20 countries. The transcripts were inductively, open-coded using thematic analysis. Generated themes were mapped systematically to four out of five domain categorisations of the Consolidated Framework for Implementation Research (CFIR); the innovation domain fell outside the scope of this study.Results Highlighted findings using CFIR are: (i) outer setting: influence of politics, lack of coordination between government departments and differing agendas towards NCDs hindered implementation while reliable and trustworthy government connections proved useful; (ii) inner setting: commitment of resources for implementation was a challenge while research capacity, work culture and trustworthy networks facilitated implementation; (iii) individuals: high-level stakeholder support and leadership was essential; (iv) process: extensive time and efforts required for stakeholder engagement towards local contextualisation was challenging, while collaborating, joint reflection, effective communication and adaptation facilitated. COVID-19 provided both challenges and opportunities and these varied depending on the intervention characteristics and study objectives.Conclusion Researchers supporting the scale-up of complex interventions targeting NCDs need to leverage on existing trusting relationships and foster equitable stakeholder partnerships through research. Interpersonal skills and good communication are essential complements to research expertise and must be considered during capacity building

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

IntroductionThere 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 analysisWe 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 TPand conduct multistakeholder qualitative interviews to gather data at T0and T1.We will undertake descriptive statistical analysis of TPdata and analyse T0and T1data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.Ethics and disseminationThe 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.</jats:sec