BackgroundIt is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South–North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice.MethodsThe implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research.ResultsThe implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open-access learning platform with tools and resources, ethical guidelines for research, policy recommendations, and academic contributions to the global SDH discourse.ConclusionsThe effective triangulation of S-N-S partnerships can be of high value in building sustainable research capacity in LMICs. If designed appropriately, these multicultural, multi-institutional, and multidisciplinary collaborations can enable southern and northern academics to contextualize global research according to their national realities.

BackgroundAlthough the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution.Methods and designWe will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention’s effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up.The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer.DiscussionThis study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system. Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical populations in Mexico and Latin America.Trial registrationClinicaltrials.gov Identifier: NCT01910935. Date of registration: 07/05/2013.

Exposure to migration may predict reduction in PA in school-age children left behind in Mexican rural communities from the State of Morelos. These findings call for PA-tailored interventions that consider household migration characteristics.

Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.

Background: Offering widespread access to training, massive open online courses (MOOCs) are regarded in the literature as a tool for democratizing knowledge. However, to be universal they must be culturally contextualized and have access to broadband Internet with adequate connectivity. Aiming to strengthen capacities in low- and middle-income countries, the SDH-Net multicenter consortium created a 10-hour MOOC specifically designed to enhance understanding of the social determinants of health (SDH). Methods: This is crucial for tackling health inequalities through public policy. Using a mixed methods approach, we evaluated the implementation of the SDH-Net MOOC from the perspective of e-literacy, Internet connectivity, course contents and instructional design: we administered a questionnaire to a pilot group of 29 course participants from Brazil, Colombia, Kenya, Mexico, South Africa and Tanzania, and conducted semi-structured interviews with a subset of 15 individuals who had completed the course. Results: While participants in general considered the content of the course adequate, those who were not English speakers found certain instructions somewhat unclear and 55% of respondents experienced difficulties with Internet connectivity and speed. Therefore, a key finding of this study was that binomial e-literacy-technological access play a major role in enrollment in, and completion of MOOCs. Conclusions: Course design is reflected in all course elements, such as the definition of competencies, instructional objectives, learning activities using multimedia resources and evaluations for each thematic unit, and these are central to the acceptability and effectiveness of MOOCs. These results shed light on the discussion regarding the function of MOOCs as a tool for democratizing knowledge and cast doubts on their usefulness in mainstreaming global health knowledge.