{
  "abstract": "Objective To assess factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 at primary healthcare (PHC) facilities in Nepal after healthcare workers received training.Design Cross-sectional study.Setting PHC facilities across various provinces in Nepal.Participants A total of 180 healthcare workers trained in PEN, recruited from a random selection of 105 basic healthcare facilities.Main outcome measures The adoption of PEN Protocol 1 components: blood pressure measurement, blood glucose screening, 10-year cardiovascular disease (CVD) risk assessment using WHO/International Society of Hypertension risk charts and body mass index (BMI) assessment. Factors associated with protocol adoption were assessed using generalised estimating equations for ORs.Results Among participants, 100% reported measuring blood pressure, while 56% measured blood sugar, 28% assessed CVD risk and 27% assessed BMI. The adoption of the CVD risk prediction chart was positively associated with the availability of amlodipine (adjusted OR (aOR) 3.00; 95% CI 1.09 to 8.27). The adoption of BMI assessment was positively associated with access to a stadiometer (aOR 3.23; 95% CI 1.26 to 8.30) and a glucometer (aOR 3.07; 95% CI 1.12 to 8.40), and negatively associated with lack of motivation/inertia of previous practice (aOR 0.60; 95% CI 0.42 to 0.87) and environmental factors such as lack of time and resources (aOR 0.57; 95% CI 0.37 to 0.89). Blood glucose level measurements were positively associated with being at a PHC centre (aOR 7.34; 95% CI 2.79 to 19.3) and the availability of metformin (OR 2.40; 95% CI 1.08 to 5.29).Conclusion Adoption of PEN Protocol 1 varied by component and was influenced by resource availability, provider motivation and system barriers. Addressing these factors is key to optimising implementation in low-resource settings.",
  "authors": [
    {
      "affiliations": [
        "Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal",
        "Prayatnashil Community Development Society (PRAYAS-Nepal), Dhading, Bagmati, Nepal"
      ],
      "name": "Dinesh Timalsena"
    },
    {
      "affiliations": [
        "Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Chandani Singh Nakarmi"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Sushmita Mali"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Aarati Dhakal"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Alina Bharati"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Anupama Bishwokarma"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Asmita Adhikari"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Bikram Poudel"
    },
    {
      "affiliations": [
        "Kathmandu University Hospital, Dhulikhel, Nepal"
      ],
      "name": "Binuka Kulung Rai"
    },
    {
      "affiliations": [
        "Department of Health Services (DoHS), Government of Nepal, Kathmandu, Nepal"
      ],
      "name": "Phanindra Prasad Baral"
    },
    {
      "affiliations": [
        "Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway",
        "Institute for Implementation Science and Health, Kathmandu, Nepal"
      ],
      "name": "Sanju Bhattarai"
    },
    {
      "affiliations": [
        "World Health Organization, Kathmandu, Nepal"
      ],
      "name": "Lonim Dixit"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Yashashwi Pokharel"
    },
    {
      "affiliations": [
        "Hubert Department of Global Health, Rollins School of Public Health, Emory University, Emory, Georgia, USA"
      ],
      "name": "Elizabeth Rhodes"
    },
    {
      "affiliations": [
        "SMU Institute for Global Health (SIGHT), Southern Medical University, Guangzhou, Guangdong, People's Republic of China",
        "School of Health Management and Dermatological Hospital, Southern Medical University, Guangzhou, Guangzhou, People's Republic of China"
      ],
      "name": "Dong Roman Xu"
    },
    {
      "affiliations": [
        "Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Donna Spiegelman"
    },
    {
      "affiliations": [
        "Dhulikhel Hospital, Dhulikhel, Nepal"
      ],
      "name": "Archana Shrestha"
    }
  ],
  "title": "Factors associated with the adoption of the WHO Package of Essential Non-Communicable Diseases (PEN) Protocol 1 in primary healthcare settings in Nepal: a cross-sectional study",
  "uid": "0647f586-e1bd-5eeb-b60a-5d80e071046a"
}