The role of contextualisation in enhancing non-communicable disease programmes and policy implementation to achieve health for all

Abstract

The September 2019 United Nations' High-Level Meeting renewed political commitments to invest in universal health coverage by strengthening health systems, programmes and policies to achieve 'health for all'. This Political Declaration is relevant to addressing the increasing global burden of non-communicable diseases, but how can evidence-based programmes and policies be meaningfully implemented and integrated into local contexts? In this Commentary, we describe how the process of contextualisation and associated tools, such as ecological frameworks, implementation research frameworks, health system indicators, effective system strengthening strategies and evidence mapping databases with priority-setting, can enhance the implementation and integration of non-communicable disease prevention and control policies and programmes. Examples across health platforms include (1) population approaches to reducing excess sodium intake, (2) fixed-dose combination therapy for cardiovascular disease prevention and control, and (3) health systems strengthening for improving the quality and safety of cardiovascular care. Contextualisation is needed to transfer evidence into locally relevant and impactful policies and programmes. The systematic and comprehensive use of contextualisation tools leverages key implementation research principles to achieve 'health for all'.

The Effect of Community-Based Exercise on Health Outcomes for Indigenous Peoples with Type 2 Diabetes: A Systematic Review

“…As such, this review highlights the limited translational research evaluating the health impacts of community-based, supervised group exercise interventions for Indigenous populations with T2D. Furthermore, in support of current recommendations, this review determined that to best facilitate the development of robust, feasible, and culturally safe evidence in this domain, interventions should be adequately contextualised to culture through consistently strong Indigenous governance and community engagement [ 37 , 38 , 50 , 51 ].…”

“…With consideration of the small number of included studies, this review found that community-based exercise can improve glycaemic control [ 12 ], anthropometric measures [ 10 , 12 ], blood lipids [ 12 ], haemodynamic measures [ 10 ], patient activation [ 12 ], and quality of life [ 10 ] in Indigenous peoples with T2D [ 17 , 30 , 31 ]. However, upon comparing the two featured interventions [ 10 , 11 , 12 ], these adaptations appear to be largely dependent on successful cultural contextualisation of the intervention and subsequently, greater participation in the planned intervention [ 37 , 38 , 50 , 51 , 52 , 53 , 54 ]. Shah et al [ 12 ] demonstrated that biomedical outcomes, including glycaemic control, can be improved with group walking and aerobic exercise programmes as part of a holistic lifestyle intervention, including education and individualised nutrition advice.…”

“…As such, with the exception of Indigenous governance (due to inadequate levels of Indigenous leadership), this intervention met all other CET criteria and was determined to have strong community engagement [ 12 , 37 , 38 ]. In conjunction with wider literature [ 37 , 38 , 50 , 51 , 52 , 53 ], it can, therefore, be hypothesised that the strong community engagement contributed to the 100% compliance rate and the significant improvement in biomedical outcomes [ 12 ].…”

Polypill: Benefits Seen for Stroke and Other Outcomes

“…Furthermore, they have to be tailored to the national and cultural context and the available resources. 31 Screening for vascular risk, individual focused motivational education, and motivation for a better adherence to medications provided as polypills can be performed by community health workers (CHWs), trained volunteers from stroke support organizations or medical professionals. CHWs can be facilitators and function as peer support as well as a link to the health and social services system.…”

Factors Associated With the Use of a Salt Substitute in Rural China

“…A careful assessment of contextual factors and human behavior is essential when implementing population health strategies, such as dietary salt reduction to reduce the intake of excessive sodium, which is the top-ranked dietary risk factor associated with cardiovascular diseases. 1 , 2 A significant number of strokes are caused by high blood pressure due to overconsumption of sodium. 3 , 4 There has been substantial evidence from randomized clinical trials showing that reduced sodium intake leads to a decrease in blood pressure.…”