One size does not fit all: implementation of interventions for non-communicable diseases

Breda, João; Wickramasinghe, Kremlin; Peters, David H.; Rakovac, Ivo; Oldenburg, Brian; Mikkelsen, Bente; Shao, Ruitai; Varghese, Cherian; Collins, Téa; Wall, Kristen; Farrington, Jill; Townsend, Nick

doi:10.1136/bmj.l6434

Cited by 23 publications

(29 citation statements)

References 14 publications

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“…The World Health Organization (WHO) recommended "best buys" options which target the four key modi able behavioural risk factors for NCDs [51]. However, there are major challenges in delivering of these "best buys" in the local LMIC contexts with delity [52], which could suggest that interventions need, of course, be tailored to LMIC settings and should be sensible to the social, economic, and cultural aspects of target communities if the approaches are to be effective [53]. With this respect, beyond individual-focused interventions, approaches that address larger social, environmental, and policy issues through multisectoral and multistakeholder actions are more important in bringing about behavioural changes in lifestyles that could essentially promote healthy living and impact the reduction of NCDs [54].…”

Section: Discussionmentioning

confidence: 99%

Guiding the design of behavioural and lifestyle modification interventions for risk reduction, prevention, and treatment of non-communicable diseases in low- and middle-income countries: An overview of relevant literature

Negussie¹,

Yalew

Kidane

2021

Preprint

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BackgroundThe increasing burden of chronic non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) calls for the development and dissemination of effective and viable interventions. In this respect, behavioural and lifestyle modification interventions (BLMIs) offer the most effective means of addressing the underlying lifestyle behaviours associated with NCDs at multiple disease prevention levels (primordial, primary, and secondary). This review aims to provide an overview of key features and components of BCIs, as well as practical considerations when implementing in LMIC settings. Methods An exploratory approach was used to provide an overview of salient issues in the design of BLMIs. A narrative review of relevant scientific literature was conducted. Based on the review's aim, the most important themes or issues were extracted. Results Thirty-four publications were included as the most relevant literature to the topic, and eight overarching themes were identified: understanding the target health behaviour; use of behavioural health theories; applying behaviour change techniques/strategies; providing effective support and follow-up; intervention delivery formats and providers; the need for cultural sensitivity; feasibility issues; and addressing multiple lifestyle behaviours.Conclusion Targeting lifestyle and behavioural modification interventions with a proper understanding of their essential design components and practical implementation considerations is crucial in reducing the rising burden of NCDs in LMICs. The importance of conducting original researches and systematic reviews on the subject was also emphasized.

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Section: Discussionmentioning

confidence: 99%

Guiding the design of behavioural and lifestyle modification interventions for risk reduction, prevention, and treatment of non-communicable diseases in low- and middle-income countries: An overview of relevant literature

Negussie¹,

Yalew

Kidane

2021

Preprint

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“…33,34 These findings complement and strengthen existing knowledge. Breda et al 35 call for NCD prevention interventions and policies to include "multi-stakeholders" beyond the traditional health sector at all stages of consideration and development, taking into account possible competing interests, and having evidence informed and context relevant implementation. Isaranuwatchai et al 36 discuss the importance of local context in making decisions about implementing interventions for preventing NCDs, in terms of assessing "best buys, wasted buys, and contestable buys" particularly in relation to equitability and context.…”

Section: Discussionmentioning

confidence: 99%

The QUEST for Effective and Equitable Policies to Prevent Non-communicable Diseases: Co-Production Lessons From Stakeholder Workshops

Lloyd-Williams

Masters

Hyseni

et al. 2020

Int J Health Policy Manag

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Background: Non-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities. Methods: We developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach. Results: We engaged with 43 diverse stakeholders. They identified ‘healthy environment’ as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/ policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of ‘elite actors’ (ministers, public sector leaders) was seen as key to the success of NCD prevention policies. Conclusions: NCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theorybased co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.

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“…Even prioritised interventions may remain unimplemented unless they are grounded in national health system capacity and that of wider sectors that play essential roles for prevention policies. 25 In step 2, national capacities and readiness to scale and integrate interventions are assessed. Participatory implementation research with stakeholders can be used to make such assessments and identify existing capacities including workforce skillset, infrastructure and systems, and community reach, as well as areas requiring capacity building.…”

Section: Step 2: Tailoring To National Capacitiesmentioning

confidence: 99%

‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries

et al. 2022

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The ‘implementation gap’ between national plans and successful implementation is a central theme in addressing non-communicable diseases (NCDs). It is a factor that has undermined Sustainable Development Goal 3.4, which aims to achieve a one-third reduction in premature mortality from four major NCDs by 2030. Responding to the potential of implementation research to support low-income and middle-income countries to effectively advance their strategies, we describe ways to make NCD plans more robust by including implementation steps. These steps are (1) choosing some (but not all) effective and cost-effective options; (2) tailoring interventions and their scale-up to national capacity; and (3) making the priorities implementable. We illustrate with examples from several countries.

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One size does not fit all: implementation of interventions for non-communicable diseases

Cited by 23 publications

References 14 publications

Guiding the design of behavioural and lifestyle modification interventions for risk reduction, prevention, and treatment of non-communicable diseases in low- and middle-income countries: An overview of relevant literature

Guiding the design of behavioural and lifestyle modification interventions for risk reduction, prevention, and treatment of non-communicable diseases in low- and middle-income countries: An overview of relevant literature

The QUEST for Effective and Equitable Policies to Prevent Non-communicable Diseases: Co-Production Lessons From Stakeholder Workshops

‘Implementability’ matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries

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