{
  "abstract": "Objectives To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.Design A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.Setting Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.Participants Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).Interventions Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.Primary and secondary outcome measures The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).Results Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.Conclusions Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.",
  "authors": [
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands"
      ],
      "name": "Zinzi Pardoel"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands"
      ],
      "name": "Ilona Folkertsma"
    },
    {
      "affiliations": [
        "Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia"
      ],
      "name": "Anusha Ramani-Chander"
    },
    {
      "affiliations": [
        "Medicine, Monash University Stroke and Ageing Research Group, Clayton, Victoria, Australia"
      ],
      "name": "Amanda G Thrift"
    },
    {
      "affiliations": [
        "School of Population Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia"
      ],
      "name": "Rohina Joshi"
    },
    {
      "affiliations": [
        "Global Alliance for Chronic Diseases, London, UK"
      ],
      "name": "Isobel Bandurek"
    },
    {
      "affiliations": [
        "Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Josefien van Olmen"
    },
    {
      "affiliations": [
        "Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal",
        "Dhulikhel Hospital, Dhulikhel, Nepal"
      ],
      "name": "Abha Shrestha"
    },
    {
      "affiliations": [
        "Western Sydney University, Sydney, New South Wales, Australia"
      ],
      "name": "Lal B Rawal"
    },
    {
      "affiliations": [
        "University of Antwerp, Antwerp, Belgium"
      ],
      "name": "Edwin Wouters"
    },
    {
      "affiliations": [
        "Nursing, Midwifery and Social Care, The University of Manchester, Manchester, UK"
      ],
      "name": "Asri Maharani"
    },
    {
      "affiliations": [
        "University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Peter Delobelle"
    },
    {
      "affiliations": [
        "The George Institute for Global Health, Sydney, New South Wales, Australia"
      ],
      "name": "Hueiming Liu"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Hillah, Iraq",
        "Heidelberg University, Heidelberg, Germany"
      ],
      "name": "Michaela Theilmann"
    },
    {
      "affiliations": [
        "The George Institute for Global Health, Sydney, New South Wales, Australia"
      ],
      "name": "Jacqui Webster"
    },
    {
      "affiliations": [
        "Public Administration, Brawijaya University, Malang, Indonesia"
      ],
      "name": "Sujarwoto Sujarwoto"
    },
    {
      "affiliations": [
        "University of York, York, UK"
      ],
      "name": "Kamran Siddiqi"
    },
    {
      "affiliations": [
        "Public Health, Universitas Sebelas Maret, Surakarta, Indonesia"
      ],
      "name": "Ari Probandari"
    },
    {
      "affiliations": [
        "Faculty of Medicine Universitas Sebelas Maret, Surakarta, Indonesia"
      ],
      "name": "Vitri Widyaningsih"
    },
    {
      "affiliations": [
        "The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia"
      ],
      "name": "Jaime Miranda"
    },
    {
      "affiliations": [
        "The George Institute for Global Health UK, Oxford, UK"
      ],
      "name": "Puhong Zhang"
    },
    {
      "affiliations": [
        "Heidelberg University, Heidelberg, Germany"
      ],
      "name": "Lisa Stehr"
    },
    {
      "affiliations": [
        "Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA",
        "Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Lisa R Hirschhorn"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands"
      ],
      "name": "Jaap Koot"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands"
      ],
      "name": "Manna Alma"
    }
  ],
  "title": "Enablers and barriers for scaling up non-communicable disease interventions across diverse global health contexts: a qualitative study using the Consolidated Framework for Implementation Research",
  "uid": "26b004e7-3860-57b3-b24f-d069348169b1"
}