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 (2024)

(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. BMJ Open, 12(4), 1-10. Article e053122. https://doi.org/10.1136/bmjopen-2021-053122

/ 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. In: BMJ Open. 2022 ; Vol. 12, No. 4. pp. 1-10.

@article{292bf135851b4cb7abc1a4b41e739a3a,

title = "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",

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.",

keywords = "health services administration & management, protocols & guidelines, public health",

author = "Anusha Ramani-Chander and Rohina Joshi and {van Olmen}, Josefien and Edwin Wouters and Peter Delobelle and Rajesh Vedanthan and Miranda, {J Jaime} and Brian Oldenburg and Stephen Sherwood and Rawal, {Lal B} and Mash, {Robert James} and Irazola, {Vilma Edith} and Monika Martens and Maria Lazo-Porras and Hueiming Liu and Gina Agarwal and Gade Waqa and Marcolino, {Milena Soriano} and Esandi, {Maria Eugenia} and Ribeiro, {Antonio Luiz Pinho} and Ari Probandari and Francisco Gonz{\'a}lez-Salazar and Abha Shrestha and Sujarwoto Sujarwoto and Naomi Levitt and Myriam Paredes and Tomohiko Sugish*ta and Malek Batal and Yuan Li and Hassan Haghparast-Bidgoli and Violet Naanyu and He, {Feng J} and Puhong Zhang and Mfinanga, {Sayoki Godfrey} and {De Neve}, Jan-Walter and Meena Daivadanam and Kamran Siddiqi and Pascal Geldsetzer and Kerstin Klipstein-Grobusch and Huffman, {Mark D} and Jacqui Webster and Dike Ojji and Andrea Beratarrechea and Maoyi Tian and Maarten Postma and Owolabi, {Mayowa O} and Josephine Birungi and Laura Antonietti and Zulma Ortiz and Anushka Patel",

note = "Funding Information: Competing interests JvO reports Horizon2020 grants (643 692 and 825432) outside the submitted work. AGT declares funding from the National Health & Medical Research Council (NHMRC, Australia: GNT1042600, GNT1122455, GNT1171966, GNT1143155, GNT1182017), Stroke Foundation Australia (SG1807), and Heart Foundation Australia (VG102282) outside the submitted work. ML-P declares support from Fogarty International Centre, National Institutes of Health [R21TW009982], under the Global Alliance for Chronic Diseases (GACD) Diabetes ProgramProgramme. MEE reports grant funding from the Argentinian Ministry of Health (MoH) under the GACD program. AS declares funding from the Japan Agency for Medical Research & Development, as part of the GACD, outside the submitted work. FJH is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC), and is a member of the Action on Salt, and World Action on Salt, Sugar and Health (WASSH). AB declares grants from the MoH Argentina, National Institutes of Health, and World Diabetes Foundation, outside the submitted work. AP declares grant and fellowship support from the NHMRC outside the submitted work, Member of the Board of Directors, The George Institute India, and past Member of the Board of Directors, Heart Health Research Center, Beijing, PRC. RJ declares grant, outside the submitted work, from WHO Geneva, WHO South-East Asia Region (SEARO), Elrha Research for Health in Humanitarian Crises (R2HC), (Wellcome Trust, UK AID and NHS), DBT/ Wellcome Trust India Alliance and Gates Foundation. In the past 3 years, MDH has received research funding from American Heart Association, Verily, and AstraZeneca for research unrelated to this manuscript and has patents pending for heart failure polypills. The George Institute for Global Health has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines. None of the others authors has any conflict of interest to declare. Funding Information: Funding RJ is supported by the Australian National Heart Foundation (102059) and a UNSW Scientia Fellowship. Publisher Copyright: {\textcopyright} 2022 Author(s). Published by BMJ.",

year = "2022",

month = apr,

day = "18",

doi = "10.1136/bmjopen-2021-053122",

language = "English",

volume = "12",

pages = "1--10",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "4",

}

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', BMJ Open, vol. 12, no. 4, e053122, pp. 1-10. https://doi.org/10.1136/bmjopen-2021-053122

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. /.
In: BMJ Open, Vol. 12, No. 4, e053122, 18.04.2022, p. 1-10.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries

T2 - protocol for a longitudinal mixed-methods study

AU - Ramani-Chander, Anusha

AU - Joshi, Rohina

AU - van Olmen, Josefien

AU - Wouters, Edwin

AU - Delobelle, Peter

AU - Vedanthan, Rajesh

AU - Miranda, J Jaime

AU - Oldenburg, Brian

AU - Sherwood, Stephen

AU - Rawal, Lal B

AU - Mash, Robert James

AU - Irazola, Vilma Edith

AU - Martens, Monika

AU - Lazo-Porras, Maria

AU - Liu, Hueiming

AU - Agarwal, Gina

AU - Waqa, Gade

AU - Marcolino, Milena Soriano

AU - Esandi, Maria Eugenia

AU - Ribeiro, Antonio Luiz Pinho

AU - Probandari, Ari

AU - González-Salazar, Francisco

AU - Shrestha, Abha

AU - Sujarwoto, Sujarwoto

AU - Levitt, Naomi

AU - Paredes, Myriam

AU - Sugish*ta, Tomohiko

AU - Batal, Malek

AU - Li, Yuan

AU - Haghparast-Bidgoli, Hassan

AU - Naanyu, Violet

AU - He, Feng J

AU - Zhang, Puhong

AU - Mfinanga, Sayoki Godfrey

AU - De Neve, Jan-Walter

AU - Daivadanam, Meena

AU - Siddiqi, Kamran

AU - Geldsetzer, Pascal

AU - Klipstein-Grobusch, Kerstin

AU - Huffman, Mark D

AU - Webster, Jacqui

AU - Ojji, Dike

AU - Beratarrechea, Andrea

AU - Tian, Maoyi

AU - Postma, Maarten

AU - Owolabi, Mayowa O

AU - Birungi, Josephine

AU - Antonietti, Laura

AU - Ortiz, Zulma

AU - Patel, Anushka

N1 - Funding Information:Competing interests JvO reports Horizon2020 grants (643 692 and 825432) outside the submitted work. AGT declares funding from the National Health & Medical Research Council (NHMRC, Australia: GNT1042600, GNT1122455, GNT1171966, GNT1143155, GNT1182017), Stroke Foundation Australia (SG1807), and Heart Foundation Australia (VG102282) outside the submitted work. ML-P declares support from Fogarty International Centre, National Institutes of Health [R21TW009982], under the Global Alliance for Chronic Diseases (GACD) Diabetes ProgramProgramme. MEE reports grant funding from the Argentinian Ministry of Health (MoH) under the GACD program. AS declares funding from the Japan Agency for Medical Research & Development, as part of the GACD, outside the submitted work. FJH is partially funded by the National Institute for Health Research (NIHR) and the Medical Research Council (MRC), and is a member of the Action on Salt, and World Action on Salt, Sugar and Health (WASSH). AB declares grants from the MoH Argentina, National Institutes of Health, and World Diabetes Foundation, outside the submitted work. AP declares grant and fellowship support from the NHMRC outside the submitted work, Member of the Board of Directors, The George Institute India, and past Member of the Board of Directors, Heart Health Research Center, Beijing, PRC. RJ declares grant, outside the submitted work, from WHO Geneva, WHO South-East Asia Region (SEARO), Elrha Research for Health in Humanitarian Crises (R2HC), (Wellcome Trust, UK AID and NHS), DBT/ Wellcome Trust India Alliance and Gates Foundation. In the past 3 years, MDH has received research funding from American Heart Association, Verily, and AstraZeneca for research unrelated to this manuscript and has patents pending for heart failure polypills. The George Institute for Global Health has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines. None of the others authors has any conflict of interest to declare.Funding Information:Funding RJ is supported by the Australian National Heart Foundation (102059) and a UNSW Scientia Fellowship.Publisher Copyright:© 2022 Author(s). Published by BMJ.

PY - 2022/4/18

Y1 - 2022/4/18

N2 - 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.

AB - 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.

KW - health services administration & management

KW - protocols & guidelines

KW - public health

UR - http://www.scopus.com/inward/record.url?scp=85128553860&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2021-053122

DO - 10.1136/bmjopen-2021-053122

M3 - Article

C2 - 35437244

SN - 2044-6055

VL - 12

SP - 1

EP - 10

JO - BMJ Open

JF - BMJ Open

IS - 4

M1 - e053122

ER -

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 Apr 18;12(4):1-10. e053122. doi: 10.1136/bmjopen-2021-053122