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Ramani-Chander A, Joshi R, van Olmen J, Wouters E, Delobelle P, Vedanthan R, Miranda JJ, Oldenburg B, Sherwood S, Rawal LB, Mash RJ, Irazola VE, Martens M, Lazo-Porras M, Liu H, Agarwal G, Waqa G, Marcolino MS, Esandi ME, Ribeiro ALP, Probandari A, González-Salazar F, Shrestha A, Sujarwoto S, Levitt N, Paredes M, Sugishita T, Batal M, Li Y, Haghparast-Bidgoli H, Naanyu V, He FJ, Zhang P, Mfinanga SG, De Neve JW, Daivadanam M, Siddiqi K, Geldsetzer P, Klipstein-Grobusch K, Huffman MD, Webster J, Ojji D, Beratarrechea A, Tian M, Postma M, Owolabi MO, Birungi J, Antonietti L, Ortiz Z, Patel A, Peiris D, Schouw D, Koot J, Nakamura K, Tampubolon G, Thrift AG. 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. BMJ Open 2022; 12:e053122. [PMID: 35437244 PMCID: PMC9016402 DOI: 10.1136/bmjopen-2021-053122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Josefien van Olmen
- Department of Family Health and Population Medicine, University of Antwerp, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, Faculty of Social Sciences, Univesrity of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative of Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit, Brussel, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- Department of Cardiovascular Research, Translation and Implementation, Baker Heart and Diabetes Institute and La Trobe University, Melbourne, Victoria, Australia
| | - Stephen Sherwood
- Fundación EkoRural and Knowledge, Technology and Innovation, Wageningen University, Wageningen, The Netherlands
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, New South Wales, Australia
| | - Robert James Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Vilma Edith Irazola
- Department of Chronic Diseases-CESCAS, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Monika Martens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gade Waqa
- C-POND, Fiji National University, College of Medicine, Nursing and Health Sciences, Suva, Fiji
| | - Milena Soriano Marcolino
- Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Eugenia Esandi
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Head of Research and Innovation, Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebalas Maret, Saurakarta, Indonesia
| | - Francisco González-Salazar
- Departamento de Ciencias Básicas, Division de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Mexico
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Dhulikhel Hospital, Dhulikhel, Nepal
| | - Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Myriam Paredes
- Facultad Latinoamericana de Ciencias Sociales Sede Ecuador (FLACSO), Quito, Ecuador
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre for Public Health Research (CReSP), Montreal, Québec, Canada
| | - Yuan Li
- Nutrition and Lifestyle Program, The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Sqaure, London, UK
| | - Puhong Zhang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Heath at Peking University Health Science Center, Beijing, China
| | - Sayoki Godfrey Mfinanga
- Muhimbili Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Meena Daivadanam
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Instituet, Solna, Sweden
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, USA
- Chan Zuckerberg Biohub, San Franciso, Caliornia, USA
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacqui Webster
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Andrea Beratarrechea
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maarten Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Josephine Birungi
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI& LSHTM), Entebbe, Uganda
- The AIDS Support Organisation (TASO), Entebbe, Uganda
| | - Laura Antonietti
- Health Sciences Institute, Universidad Nacional Arturo Jauretche, Florencio Varela, Buenos Aires, Argentina
| | - Zulma Ortiz
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Anushka Patel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Darcelle Schouw
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Jaap Koot
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health,Tokyo Medical and Dental University, Tokyo, Japan
| | - Gindo Tampubolon
- Global Development Institute, University of Manchester, Manchester, UK
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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