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.

Anusha Ramani-Chander; Rohina Joshi; Josefien van Olmen; Edwin Wouters; Peter Delobelle; Rajesh Vedanthan; J Jaime Miranda; Brian Oldenburg; Stephen Sherwood; Lal B Rawal; Robert James Mash; Vilma Edith Irazola; Monika Martens; Maria Lazo-Porras; Hueiming Liu; Gina Agarwal; Gade Waqa; Milena Soriano Marcolino; Maria Eugenia Esandi; Antonio Luiz Pinho Ribeiro; Ari Probandari; Francisco González-Salazar; Abha Shrestha; Sujarwoto Sujarwoto; Naomi Levitt; Myriam Paredes; Tomohiko Sugishita; Malek Batal; Yuan Li; Hassan Haghparast-Bidgoli; Violet Naanyu; Feng J He; Puhong Zhang; Sayoki Godfrey Mfinanga; Jan-Walter De Neve; Meena Daivadanam; Kamran Siddiqi; Pascal Geldsetzer; Kerstin Klipstein-Grobusch; Mark D Huffman; Jacqui Webster; Dike Ojji; Andrea Beratarrechea; Maoyi Tian; Maarten Postma; Mayowa O Owolabi; Josephine Birungi; Laura Antonietti; Zulma Ortiz; Anushka Patel; David Peiris; Darcelle Schouw; Jaap Koot; Keiko Nakamura; Gindo Tampubolon; Amanda G Thrift;
Abstract
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.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 (T), initiation of implementation (T) and 1-year postinitiation (T). We will extract project-related data from secondary documents at T and conduct multistakeholder qualitative interviews to gather data at T and T We will undertake descriptive statistical analysis of T data and analyse T and T data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.PThe 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.
Journal BMJ OPEN
ISSN 2044-6055
Published 18 Apr 2022
Volume 12
Issue 4
Pages e053122
DOI 10.1136/bmjopen-2021-053122
Type Journal Article | Research Support, Non-U.S. Gov't
Sponsorship