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
Ramani-Chander, Anusha; Joshi, Rohina; Olmen, Josefien van; Wouters, Edwin; Delobelle, Peter; Vedanthan, Rajesh; Miranda, J Jaime; Oldenburg, Brian; Sherwood, Stephen; Rawal, Lal B; Mash, Robert James; Irazola, Vilma Edith; Martens, Monika; Lazo-Porras, Maria; Liu, Hueiming; Agarwal, Gina; Waqa, Gade; Marcolino, Milena Soriano; Esand, Maria Eugenia; Ribeiro, Antonio Luiz Pinho; Probandari, Ari; González-Salaza, Francisco; Shrestha, Abha; Sujarwoto, Sujarwoto; Levitt, Naomi; Paredes, Myriam; Sugishita, Tomohiko; Batal, Malek; Li, Yuan; Haghparast- Bidgoli, Hassan; Naanyu, Violet; He, Feng J; Zhang, Puhong; Mfinanga, Sayoki Godfrey; De Neve, Jan-Walter; Daivadanam, Meena; Siddiqi, Kamran; Geldsetzer, Pascal; Klipstein-Grobusch, Kerstin; Huffman, Mark D; Webster, Jacqui; Ojji, Dike; Beratarrechea, Andrea; Tian, Maoyi; Postma, Maarten; Owolabi, Mayowa O; Birungi, Josephine; Antonietti, Laura; Ortiz, Zulma; Patel, Anushka; Peiris, David; Darcelle Schouw, Darcelle Schouw; Koot, Jaap; Nakamura, Keiko; Tampubolon, Gindo; Thrift, Amanda G
Date:
2022-02-04
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 (T 1
). We will extract project-
related data from secondary documents at T P and conduct multistakeholder qualitative interviews to gather data at T 0 and T1. We
will undertake descriptive statistical analysis of TP data and analyse T 0
and T 1 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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