Global Alliance for Chronic Diseases partners publish hypertension findings

January / February 2016 | Volume 15, Issue 1

A female instructor on stage leads a large, outdoor exercise class
Photo by David Rochkind for Fogarty

Lifestyle modifications were among the interventions
studied by hypertension researchers funded by the Global
Alliance for Chronic Diseases.

​​Research findings on behavior change strategies to reduce hypertension have been published by a consortium of scientists funded by the Global Alliance for Chronic Diseases (GACD). The Alliance, a partnership of international research funders, was formed to focus on implementation science that will lessen the burden of chronic diseases in low- and middle-income countries (LMICs) and among other vulnerable populations.

Scientists reported there was "marked variation" in the perceived capabilities, opportunities and motivation of the various entities being targeted for behavior change strategies to lower blood pressure (BP). "This suggests that the ability to change behavior differs greatly across regions and between actors," the study team noted in a recent article in the journal, Implementation Science.

Hypertension was the GACD's first research topic selected, with 15 projects funded to study how best to prevent, manage and control elevated BP. One of the greatest modifiable risk factors for disease, high BP is responsible for about 9.4 million deaths annually - with over 80 percent of those occurring in LMICs - according to the Global Burden of Disease 2010 study.

Although there was great variation in behavior change ratings, the scientists observed a high degree of synergy in the types of projects funded. Most were multifaceted, focusing on education and behavior change strategies. They drew on "softer" policy levers, such as guidelines, communication/marketing and service provision, rather than restrictive government regulation or legislation.

All of the research teams - working in 15 LMICs and Aboriginal communities in Canada - initially collaborated on a mapping exercise to study aspects of behavior change in their target populations and provide a benchmark to gauge progress. Projects broadly aligned to two topic areas - interventions in health care delivery, or measures to reduce salt intake or test salt substitutes.

The overarching program goals are to better understand barriers and facilitators at local and national levels, learn how innovations for BP control can be introduced and scaled up, and identify what health system elements must be strengthened to improve BP control and reduce health disparities.

By working together, the teams were able to synthesize common elements across research projects and encourage cross-fertilization of ideas. Another benefit of the GACD is the close relationship between the researchers and the funding agencies, the scientists said, so results can be used to inform future research funding calls.

Although the investigators had expected similar actors surveyed in each location to exhibit similar characteristics, they found there was a high degree of variability. That indicates the actors themselves and the local contexts in which they operate may be different. "Further, the interventions themselves, although similar in nature are complex," the scientists said. "And the extent to which they are tailored to the regions in which they are working are likely to be a critical driver of outcomes."

The actor-context-intervention relationships are key to understanding why similar interventions may produce different outcomes, and why similar actors may adopt interventions differently, according to the research partners. They said the main strength of the endeavor is the collaborative nature of the work and suggested their final process evaluations may hold important lessons for the broader global community.

"The outcomes of such activities are instructive for funding agencies and will help inform how global research programs can be developed into 'implementation laboratories,' thereby, delivering new knowledge that extends beyond the individual research projects that they fund," the authors concluded.

The GACD has issued subsequent funding calls for diabetes and environmental lung disease research. A request for proposals related to mental health is being planned.

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