RT Journal Article
SR Electronic
T1 Design and Implementation of Brief Interventions to Address Noncommunicable Diseases in Uzbekistan
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2300443
DO 10.9745/GHSP-D-23-00443
VO 12
IS 4
A1 Alonge, Olakunle
A1 Homsi, Maysam
A1 Rizvi, Mahnoor Syeda
A1 Malykh, Regina
A1 Geffert, Karin
A1 Kasymova, Nazokat
A1 Tilenbaeva, Nurshaim
A1 Isakova, Lola
A1 Kushubakova, Maria
A1 Mavlyanova, Dilbar
A1 Mamyrbaeva, Tursun
A1 Duishenkulova, Marina
A1 Pinedo, Adriana
A1 Andreeva, Olga
A1 Wickramasinghe, Kremlin
YR 2024
UL http://www.ghspjournal.org/content/12/4/e2300443.abstract
AB Key MessagesBrief interventions (BIs), implemented by clinicians in primary health care settings, are ways to address the growing burden of noncommunicable diseases (NCDs) in low- and middle-income countries.Pathways for the large-scale implementation of BIs in Uzbekistan include key strategies (e.g., supportive supervision and audit feedback), implementation outcomes (e.g., acceptability of the interventions by different stakeholders), and intermediate outcomes (e.g., changes to clinicians’ knowledge and self-efficacy to practice counseling for NCD risk factors).To achieve large-scale effectiveness with BIs, policymakers and program managers should consider key health system challenges, including shortages of human resources for health, clinician incentives, improvements to data systems and use, and performance monitoring.In Uzbekistan, NCDs, including cardiovascular diseases, cancer, and diabetes, accounted for over 80% of mortality in 2019. In 2021, national stakeholders, in conjunction with the World Health Organization, identified brief interventions (BIs) to implement in primary health care settings to change unhealthy behaviors and reduce the burden of NCDs in the country. BIs consist of a validated set of questions to identify and measure NCD behavioral risk factors and a short conversation with patients/clients about their behavior, as well as the provision of a referral opportunity for further in-depth counseling or treatment if needed. We used a multimethod approach of document review, participatory workshops, and key informant interviews to describe how BIs were designed and implemented in Uzbekistan and generated a theory of change for its large-scale implementation. BIs in Uzbekistan targeted 4 risk factors (alcohol use, tobacco use, unhealthy diet, and physical inactivity) and entailed training clinicians on how to conduct behavioral change counseling using the 5As and 5Rs toolkit, conducting supportive supervision, and using feedback to improve service delivery. The program was collaboratively designed by multiple stakeholders across sectors, including the Ministries of Health, Higher Education, Science, and Innovations, with buy-in from key political leaders. The potential impact of the program (i.e., reducing the incidence of NCDs) was mediated by several intermediate and implementation outcomes at the individual, primary care, and community levels operating along multiple pathways. Significant health system challenges remain to the program, such as limited human resources, lack of incentives for clinicians, outdated systems and data collection processes for performance monitoring, and coordination among different relevant sectors. These and other challenges will need to be addressed to ensure the effective large-scale implementation of BIs in Uzbekistan and similar LMICs.