Process evaluation of complex interventions in non-communicable and neglected tropical diseases in low- and middle-income countries: a scoping review

Abstract

ObjectivesThe aim of this review is to map out the use of process evaluation (PE) in complex interventions that address non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) to identify gaps in the design and conduct, as well as strengths, limitations and implications, of this type of research in low- and middle-income countries (LMICs).DesignScoping review of PE studies of complex interventions implemented in LMICs. Six databases were searched focused on studies published since 2008.Data sourcesEmbase, PubMed, EbscoHost, Web of Science (WOS), Virtual Health Library (VHL) Regional Portal and Global Index Medicus: Regional Indexes AIM (AFRO), LILACS (AMRO/PAHO), IMEMR (EMRO), IMSEAR (SEARO), WPRIM (WPRO) Global Index Regional Indexes, MEDLINE, SciELO.Eligibility criteriaStudies conducted in LMICs on PEs of randomised controlled trials (RCTs) and non-RCTs published between January 2008 and January 2020. Other criteria were studies of interventions for people at risk or having physical and mental NCDs, and/or NTDs, and/or their healthcare providers and/or others related to achieve better health for these two disease groups. Studies were excluded if they were not reported in English or Spanish or Portuguese or French, not peer-reviewed articles, not empirical research and not human research.Data extraction and synthesisData extracted to be evaluated were: available evidence in the utilisation of PE in the areas of NCDs and NTDs, including frameworks and theories used; methods applied to conduct PEs; and in a subsample, the barriers and facilitators to implement complex interventions identified through the PE. Variables were extracted and categorised. The information was synthesised through quantitative analysis by reporting frequencies and percentages. Qualitative analysis was also performed to understand facilitators and barriers presented in these studies. The implications for PEs, and how the information from the PE was used by researchers or other stakeholders were also assessed in this approach.Results303 studies were identified, 79% were for NCDs, 12% used the label ‘PE’, 27% described a theory or framework for the PE, and 42% used mixed methods to analyse their findings. Acceptability, barriers and facilitators to implement the interventions, experiences and perceptions, and feasibility were the outcomes most frequently evaluated as part of the PEs. Barriers and facilitators themes identified were contextual factors, health system factors, human resources, attitudes and policy factors.ConclusionsPEs in NCDs and NTDs are used in LMICs with a wide variety of methods. This review identified many PEs that were not labelled by the authors as such, as well as a limited application of PE-related theories and frameworks, and heterogeneous reporting of this type of study.

Process evaluation of implementation of the early stages of a whole systems approach to obesity in a small Island

“…Adaptations to the structure of the CWT and the networks that surround the CWT are needed to ensure knowledge and labour are spread broadly across a wide network of individuals and organisations. These human resource factors are common to other complex implementation experiences [ 28 ].…”

Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components

“…However, the field of process evaluation in co-creation is to be researched further. As previous reviews recommend, 105 106 it is yet to be understood why process evaluation frameworks are so scarcely applied. The results from the current review align with those of two separate reviews on the use of process evaluation by Lazo-Porras et al 105 and Liu et al 106 in chronic and neglected tropical diseases in low-income and middle-income countries and in primary care interventions addressing chronic disease.…”

“…As previous reviews recommend, 105 106 it is yet to be understood why process evaluation frameworks are so scarcely applied. The results from the current review align with those of two separate reviews on the use of process evaluation by Lazo-Porras et al 105 and Liu et al 106 in chronic and neglected tropical diseases in low-income and middle-income countries and in primary care interventions addressing chronic disease. Both studies indicate a low percentage of included studies that reference existing frameworks in process evaluation (12% and 31%, respectively).…”

“…Both studies indicate a low percentage of included studies that reference existing frameworks in process evaluation (12% and 31%, respectively). Among recommendations for the use of process evaluation in the study by Lazo-Porras et al , 105 was to standardise reporting to ensure consistency and comparability among studies.…”