BMJ Open (Apr 2022)
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
- Josefien van Olmen,
- Peter Delobelle,
- Meena Daivadanam,
- Hassan Haghparast-Bidgoli,
- Maria Lazo-Porras,
- J Jaime Miranda,
- Anushka Patel,
- David Peiris,
- Yuan Li,
- Rohina Joshi,
- Amanda G Thrift,
- Rajesh Vedanthan,
- Maoyi Tian,
- Gina Agarwal,
- Mark D Huffman,
- Kerstin Klipstein-Grobusch,
- Naomi Levitt,
- Dike Ojji,
- Feng J He,
- Maarten Postma,
- Kamran Siddiqi,
- Pascal Geldsetzer,
- Puhong Zhang,
- Milena Soriano Marcolino,
- Lal B Rawal,
- Hueiming Liu,
- Brian Oldenburg,
- Mayowa O Owolabi,
- Jan-Walter De Neve,
- Antonio Luiz Pinho Ribeiro,
- Josephine Birungi,
- Edwin Wouters,
- Abha Shrestha,
- Ari Probandari,
- Sayoki Godfrey Mfinanga,
- Robert James Mash,
- Andrea Beratarrechea,
- Keiko Nakamura,
- Gindo Tampubolon,
- Jacqui Webster,
- Vilma Edith Irazola,
- Zulma Ortiz,
- Violet Naanyu,
- Jaap Koot,
- Anusha Ramani-Chander,
- Stephen Sherwood,
- Monika Martens,
- Gade Waqa,
- Maria Eugenia Esandi,
- Francisco González-Salazar,
- Sujarwoto Sujarwoto,
- Myriam Paredes,
- Tomohiko Sugishita,
- Malek Batal,
- Laura Antonietti,
- Darcelle Schouw
Affiliations
- Josefien van Olmen
- Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
- Peter Delobelle
- 5 Chronic Disease Initiative of Africa, University of Cape Town, Rondebosch, South Africa
- Meena Daivadanam
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Hassan Haghparast-Bidgoli
- Institute for Global Health, University College London, London, UK
- Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- J Jaime Miranda
- 8 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Anushka Patel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- David Peiris
- 9 The George Institute for Global Health, Sydney, New South Wales, Australia
- Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Rohina Joshi
- 12 School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rajesh Vedanthan
- Section for Global Health, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
- Gina Agarwal
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Mark D Huffman
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- Kerstin Klipstein-Grobusch
- Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Naomi Levitt
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
- Dike Ojji
- Department of Internal Medicine, University of Abuja, Abuja, Nigeria
- 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
- Maarten Postma
- Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands
- 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
- Puhong Zhang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Milena Soriano Marcolino
- Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Lal B Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, New South Wales, Australia
- Hueiming Liu
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Mayowa O Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Antonio Luiz Pinho Ribeiro
- 7 Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Josephine Birungi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Edwin Wouters
- 4 Department of Sociology, Centre for Population, Family & Health, University of Antwerp, Antwerpen, Belgium
- Abha Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, Nepal
- Ari Probandari
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Sayoki Godfrey Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research Tanzania, Dar es Salaam, Tanzania, United Republic of
- Robert James Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- Andrea Beratarrechea
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- 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
- Jacqui Webster
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Vilma Edith Irazola
- Department of Chronic Diseases—CESCAS, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Zulma Ortiz
- chief of training and research department
- Violet Naanyu
- 4 Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Jaap Koot
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
- Anusha Ramani-Chander
- 1 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stephen Sherwood
- 10 Fundacion Ekorural, Quito, Ecuador
- Monika Martens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Gade Waqa
- C-POND, Fiji National University, College of Medicine, Nursing and Health Sciences, Suva, Fiji
- Maria Eugenia Esandi
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
- Francisco González-Salazar
- Departamento de Ciencias Básicas, Division de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Mexico
- Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
- 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
- Laura Antonietti
- Health Sciences Institute, Universidad Nacional Arturo Jauretche, Florencio Varela, Buenos Aires, Argentina
- Darcelle Schouw
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- DOI
- https://doi.org/10.1136/bmjopen-2021-053122
- Journal volume & issue
-
Vol. 12,
no. 4
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.
