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. 2021 Mar 25;18(7):3391.
doi: 10.3390/ijerph18073391.

Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol

Mari Carmen Bernal-Soriano  1   2 , Francisco Barrera-Guarderas  3 , Alfonso Alonso-Jaquete  4 , Elisa Chilet-Rosell  1 , Ikram Benazizi  1 , Cintia Caicedo-Montaño  5 , Mónica Márquez-Figueroa  5 , Marta Puig-García  1 , Blanca Lumbreras  1   2 , Ildefonso Hernández-Aguado  1   2 , Ana Lucía Torres-Castillo  6 , Lucy Anne Parker  1   2
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Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol

Mari Carmen Bernal-Soriano et al. Int J Environ Res Public Health. .

Abstract

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Keywords: diabetes mellitus; diabetes type 2; health systems; implementation science; low- and middle-income countries; public health.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study design and description of the phases that constitute it. * The project website is https://www.ceadproject.eu/ accessed on 15 January 2021.
Figure 2
Figure 2
Purposive selection criteria for focus group participants and axes for discussion of diabetes care implementation challenges.
See this image and copyright information in PMC

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