Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

Abstract

Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.

Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries—A Systematic Review

“…Without targeted contextualized (13) and appropriately communicated guidelines, care providers, patients, policy makers, payers, and communities are not guided adequately on the best practices to yield better outcomes (13). Considerations for contextualization should include factors related to each of the stakeholders, including external contextual factors (policies, incentivization structures, dominant paradigms, stakeholders' buy-in, infrastructure, and advances in technology), organizationrelated factors (culture, available resources, integration with existing processes, relationships, skill mix, and staff involvement), and individual professional factors (professional role, underlying philosophy of care, and competencies) (13). Contextualization involves designing and fitting the recommendations to the implementation environment and vice versa.…”

“…Target audiences were divided into providers, patients, populace, policy makers, implementation partners (e.g., professional bodies, advocates, relevant nongovernmental organizations, etc. ), and payers (entities other than patient that finance or reimburse the cost of health services) (13). A guideline was deemed to have complied with each IOM standard when all the stated IOM requirements were met (18).…”

“…A guideline was judged to have ethical, legal, social, and psychological considerations when information concerning ethical dilemmas, DM-related legal issues, the impact of DM on daily routines and relationships, and psychological issues were explicitly stated. A guideline was deemed translatable when solutions were categorized according to the ease of successful implementation (13).…”

“…Adapting international guidelines to the socioeconomic context of LMIC with a focus on suitable strategies and a wider target audience might be a better option for the control of DM. It is not clear whether existing guidelines for DM in LMIC addressed these considerations in order to enhance their impact (13).…”

Mediterranean Diet and Health Promotion: evidence and current concerns

“…Several studies (Loef & Walach 2012, van Dam et al 2008, Khaw et al 2008 showed that modern food production/distribution and increased industrialization of agro-food systems have influenced significantly the worldwide dietary habit and nutritional components of eating patterns with a strong impact on nutritional outcomes (Owolabi et al 2016, World Health Organization 2011, Hawkes 2006, Garnett et al 2013, Knight et al 2016. It is widely demonstrated that eating habit as a whole, rather than an individual nutrient or groups of them, interacts with health status (Schulze & Hu 2002, Jacques & Tucker 2001, Fung et al 2001) and may have a significant influence on modifiable risk factors of noncommunicable diseases (NCDs), which are reaching epidemic proportions worldwide.…”