Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review

Abstract

Objectives: The COVID-19 pandemic has disrupted health care for non-communicable diseases (NCDs) and necessitated strategies to minimize contact with facilities. We aimed to examine factors influencing implementation of remote (non-facility-based) delivery approaches for people with hypertension and/or diabetes in low- and middle-income countries (LMICs), to inform NCD care delivery during health service disruption, including humanitarian crises.Methods: Our narrative review used a hermeneutic and purposive approach, including primary studies conducted in LMICs, which assessed implementation factors influencing remote NCD care delivery. Results were analyzed using the Consolidated Framework for Implementation Research.Results: Twenty-eight included studies revealed the strong influence of both internal organizational and broader contextual factors, such as community health worker policies or technological environment. Addressing patients’ specific characteristics, needs and resources was important for implementation success.Conclusion: This review highlighted the multiple, complex, interdependent factors influencing implementation of remote NCD care in LMICs. Our findings may inform actors designing NCD care delivery in contexts where facility-based access is challenging. Implementation research is needed to evaluate context-adapted e-Health, community-based, and simplified clinical management strategies to facilitate remote NCD care.

Lessons from the COVID-19 pandemic to strengthen NCD care and policy in humanitarian settings: a mixed methods study exploring humanitarian actors’ experiences.

“…According to the WHO, telemedicine and patient triage were the most common mitigation strategies used to reduce NCD service disruption in the early days of the pandemic [16]. However, our study re ects the literature around the introduction of telehealth -its success is highly contingent on national infrastructure, smartphone ownership rates, and on internal organisational factors, while clear guidance, training and culturally-congruent communication all support its successful implementation [27]. Our data also highlight the need for guidance for clinicians in the use of telemedicine, in keeping with previous calls for speci c WHO guidance on the development and use of digital health solutions for NCD care [19].…”

“…We focussed on the delivery of care for hypertension, type-1 and type-2 diabetes ('DM/HTN', implying care for either or all conditions) as these are the most common NCD types currently addressed by humanitarian organisations [12,26]. These conditions are also established tracer conditions, used globally by WHO for the assessment of services for crisis-affected populations delivered within public, private, and parallel health systems (including the humanitarian or informal sector) [12,27].…”

Telenursing needs and influencing factors in patients with type 2 diabetes mellitus: A cross‐sectional study

“…This showed that the closer an individual's residence to a community health centre, the easier it was to access medical resources. Access to disease resources was associated with self‐care in patients with T2DM (Favas et al, 2022). Self‐care should be improved by providing multichannel diabetes management resources.…”

Lessons on integrated chronic care organisation of primary care during the COVID-19 pandemic: case study analyses in Cambodia, Slovenia, and Belgium

“…During the COVID-19 pandemic, people living with NCDs were therefore at double risk; rstly, they were at increased risk for developing severe and even fatal COVID-19 because of their underlying condition, and secondly, since their chronic care provision was impeded, they were at risk of developing acute and long term complications. (2,(4)(5)(6)(7).…”