Zinzi Pardoel, Ilona Folkertsma, Anusha Ramani-Chander, Amanda G. Thrift, Rohina Joshi, Isobel Bandurek, Josefien van Olmen, Abha Shrestha, Lal B. Rawal, Edwin Wouters, Asri Maharani, Peter Delobelle, Hueiming Liu, Michaela Theilmann, Jacqui Webster, Sujarwoto Sujarwoto, Kamran Siddiqi, Ari Probandari, Vitri Widyaningsih, Jaime Miranda, Puhong Zhang, Lisa Stehr, Lisa R. Hirschhorn, Jaap Koot, Manna Alma
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. © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; Monash University Stroke and Ageing Research Group, Clayton, VIC, Australia; School of Population Health, University of New South Wales, New South Wales, Sydney, NSW, Australia; Global Alliance for Chronic Diseases, London, United Kingdom; Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium; Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Dhulikhel Hospital, Dhulikhel, Nepal; Western Sydney University, Sydney, NSW, Australia; University of Antwerp, Antwerp, Belgium; Nursing, Midwifery and Social Care, The University of Manchester, Manchester, United Kingdom; University of Cape Town, Rondebosch, South Africa; The George Institute for Global Health, Sydney, NSW, Australia; Faculty of Medicine, Hillah, Iraq; Heidelberg University, Heidelberg, Germany; Public Administration, Brawijaya University, Malang, Indonesia; University of York, York, United Kingdom; Public Health, Universitas Sebelas Maret, Surakarta, Indonesia; Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia; The George Institute for Global Health, Oxford, United Kingdom; Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
