Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes
Introduction Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs—dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies i...
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| Format: | Article |
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001371.full |
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| author | Kavumpurathu R Thankappan Biraj Karmacharya Jeemon Panniyammakal Brian Oldenburg Abha Shrestha Lu Yang Getu Debalkie Demissie Rolina Dhital Tilahun Haregu Ganeshkumar Parasuraman Sabrina Gupta |
| author_facet | Kavumpurathu R Thankappan Biraj Karmacharya Jeemon Panniyammakal Brian Oldenburg Abha Shrestha Lu Yang Getu Debalkie Demissie Rolina Dhital Tilahun Haregu Ganeshkumar Parasuraman Sabrina Gupta |
| author_sort | Kavumpurathu R Thankappan |
| collection | DOAJ |
| description | Introduction Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs—dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs.Methods We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention’s adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information.Results Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers.Conclusions Early community and local stakeholders’ engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population. |
| format | Article |
| id | doaj-art-60dbe7f01f534ffd8235b9c26b255df1 |
| institution | DOAJ |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-60dbe7f01f534ffd8235b9c26b255df12025-08-20T03:15:18ZengBMJ Publishing GroupBMJ Public Health2753-42942025-04-013110.1136/bmjph-2024-001371Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomesKavumpurathu R Thankappan0Biraj Karmacharya1Jeemon Panniyammakal2Brian Oldenburg3Abha Shrestha4Lu Yang5Getu Debalkie Demissie6Rolina Dhital7Tilahun Haregu8Ganeshkumar Parasuraman9Sabrina Gupta10Amrita Institute of Medical Sciences, Kochi, IndiaKathmandu University School of Medical Sciences, Kathmandu, NepalLa Trobe University, Melbourne, Victoria, AustraliaLa Trobe University, Melbourne, Victoria, AustraliaLa Trobe University, Melbourne, Victoria, AustraliaPancreatic Research Group, South Western Sydney Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, AustraliaLa Trobe University, Melbourne, Victoria, AustraliaHealth Action and Research Pvt Ltd, Kathmandu, NepalCentre for Mental Health and Community Wellbeing, The University of Melbourne, Melbourne, Victoria, AustraliaIndian Council of Medical Research, Chennai, IndiaLa Trobe University, Melbourne, Victoria, AustraliaIntroduction Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs—dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs.Methods We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention’s adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information.Results Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers.Conclusions Early community and local stakeholders’ engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population.https://bmjpublichealth.bmj.com/content/3/1/e001371.full |
| spellingShingle | Kavumpurathu R Thankappan Biraj Karmacharya Jeemon Panniyammakal Brian Oldenburg Abha Shrestha Lu Yang Getu Debalkie Demissie Rolina Dhital Tilahun Haregu Ganeshkumar Parasuraman Sabrina Gupta Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes BMJ Public Health |
| title | Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes |
| title_full | Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes |
| title_fullStr | Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes |
| title_full_unstemmed | Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes |
| title_short | Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes |
| title_sort | scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low income and middle income countries a systematic review of strategies methods and outcomes |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001371.full |
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