Multisectoral approach to tackle chronic non-communicable diseases: implementation research maximising collaboration and coordination with sectors and in settings beyond the healthcare system (GACD)

This topic aims at supporting activities that are enabling or contributing to one or several expected impacts of destination “Tackling diseases and reducing disease burden”. To that end, proposals under this topic should aim to deliver results that are directed at, tailored towards and contributing to some of the following expected outcomes:

• Researchers, policymakers, healthcare- and non-healthcare-related stakeholders and authorities in low- and middle-income countries (LMICs)^[1] and/or those in high-income countries (HICs) serving disadvantaged populations have access to improved insights and evidence on how to maximise collaboration and coordination with sectors and in settings beyond the healthcare system in the context of Non-Communicable Diseases (NCDs).
• Researchers, policymakers, healthcare- and non-healthcare-related stakeholders and authorities have an improved understanding how the proposed interventions draw on collaborative multisectoral engagement and utilise the different settings in which people are educated, work and live, to expand efforts to reduce risks, prevent, manage and control NCDs.
• Communities, relevant stakeholders from different sectors and authorities are fully engaged in implementing and taking up interventions that tackle the growing burden of NCDs through actions in sectors and settings outside the traditional health system and its facilities health-related outcomes, improve quality of life across the life course and extend healthy life expectancy.

The Commission is a member of the Global Alliance for Chronic Diseases (GACD)^[2]. The GACD specifically addresses NCDs and supports implementation research^[3] to improve health outcomes. This topic is launched in concertation with the other GACD members (international funding agencies) and aligned with the 11^th GACD call.

Besides health-related determinants, the burden of NCDs is also driven by structural and social inequities, population ageing, the effects of globalisation on marketing and trade, diet and activity, commercial and economic determinants of health, rapid urbanisation and climate change, factors over which a conventional healthcare-oriented system has little sway. There is a need for a comprehensive approach, involving sectors outside of health, to meet the global targets that governments have agreed upon to protect people from chronic NCDs. Tackling chronic NCDs most effectively therefore requires engagement and coordinated policy development within and across many government departments, including education, workplace, environment, social systems, housing, transportation, agriculture, food industry and nutrition, leisure and culture.

The aim of this topic is to fund implementation research focused on strategies to tackle the growing burden of NCDs through actions in sectors and settings outside the traditional health system^[4] and its facilities (with or without the involvement of the healthcare system) to attain equitable health-related outcomes or influence health determinants for people living in LMICs, and/or underserved populations in HICs.

Proposals can focus on more than one setting and/or include cross-sectoral approaches, involving both health and non-health settings to expand efforts to reduce risks, prevent, manage and control NCDs. Safety is a major concern in non-health settings, and proposals should ensure any risks and safety considerations are addressed.

The choice of intervention(s)^[5] and provision of existing evidence of the intervention’s effectiveness, cost-effectiveness, sustainability, scalability and potential for long-term health and other impacts should be justified (and in what context this evidence has been generated).

The majority of evidence-based interventions implemented outside of the health sector focus on prevention of NCDs: relatively few focus on strategies for management of these chronic conditions, and a limited number are implemented in LMIC contexts or underserved communities. Therefore, it may be important to undertake formative research as a part of the proposal to support readiness for implementation.

Applicants should explore the implementation of proposed intervention(s) for a selected study population(s) based in one or more LMICs, and/or underserved populations experiencing health disparities, including Indigenous populations, in HICs, considering the unique social, political, economic, and cultural context(s) in which the study will take place^[6]. Applicants should justify why any adaptation will not compromise the known effectiveness of the selected intervention(s).

Proposals should address all the following implementation research activities^[7]:

• Clearly describe the implementation research methodology, including the statistical design, and provide a rationale for the implementation strategy/ies to be explored (in light of the context), the community/population group(s) to benefit, the settings and sectors involved (and how these should be engaged), the current state of the art and how the proposal improves on this, and, if used, the theories, models and/or frameworks underpinning the research.
• Have an appropriate strategy for measuring implementation research outcomes and real-world effectiveness outcomes and indicators.
• Specifically address issues of equitable implementation to ensure interventions reach the populations that need them the most.
• Engage an appropriately expert and skilled research team which can ensure a suitable multidisciplinary approach and that demonstrates equitable partnership and shared leadership between HIC-LMIC, and/or non-Indigenous-Indigenous members of the project team and external stakeholders through a clear governance strategy.
• Provide a stakeholder engagement strategy with evidence of support/engagement from key stakeholders for delivering the intervention and a pathway to sustain the proposed intervention (if proven effective) after the funding from the GACD grant ends.
• Provide opportunities for implementation research capacity building for early career researchers and team members from lower resourced environments, such as LMICs or disadvantaged communities.
• Ensure meaningful involvement of early career team members, including at least one early career member as a co-investigator.

The study population may include the general population, people with one or more existing NCDs, those currently without NCDs, or a combination of both. Applicants may propose implementation research focused on interventions that are implemented at the individual, family, community (e.g. work or school), population, and/or structural level. With regard to NCDs, applicants are encouraged to explore any chronic non-communicable condition (or combination of conditions), including mental health disorders, substance use disorders, autoimmune conditions, musculoskeletal conditions, neurological disorders and sleep disorders and/or any risk factor (or combination of risk factors). Additionally, whenever relevant, applicants are also encouraged to take a life course approach, adapting interventions for particular life stages with the goal of promoting life-long health.

Proposals should use an appropriate implementation research design and frameworks^[8], cluster Randomised Control Trials (cRCTs), before and after studies, and additional implementation science classifications of study designs (e.g. hybrid designs^[9]), noting that applicants are not limited to any particular design.

Proposals are expected to generate evidence that is of direct relevance to policymakers, communities and practitioners. Proposed work should develop a strategy to include the relevant policymakers, local authorities, as well as other stakeholders such as community groups, or other individuals or organisations involved in the implementation of the intervention, with co-creation from the development of the proposal through to the knowledge translation phase. Project partners should be engaged from the beginning to contribute to the sustainability of the intervention after the end of project. Proposals should demonstrate sustainability of the strategy, beyond the lifespan of the project.

Poverty, discrimination based on sex, racial or ethnic origin^[10], religion or belief, disability, age, and other inequities are directly associated with reduced potential for equitable access to quality care. Proposals should consider relevant determinants of health (e.g. social, structural, commercial, economic) and discuss their potential impact on the effective implementation of the intervention(s). If there is a focus on a particular population (e.g. gender, racial or ethnic origin^[10], etc.), then the reason for this should be justified.

This topic requires the effective contribution of social sciences and humanities (SSH) disciplines and the involvement of SSH experts, institutions as well as the inclusion of relevant SSH expertise, in order to produce meaningful and significant effects enhancing the societal impact of the related research activities.

All projects funded under this topic are strongly encouraged to participate in networking and joint activities, including internationally, as appropriate. These activities could, for example, involve the participation in joint workshops, the Annual Scientific Meetings of the GACD, the exchange of knowledge, the development and adoption of best practices, or joint communication activities. Therefore, proposals are expected to include a budget for such activities and should consider covering the costs of any other potential joint activities without the prerequisite to detail concrete joint activities at this stage. The details of these joint activities will be defined during the grant agreement preparation phase.

Applicants should provide details of their clinical studies^[12] in the dedicated annex using the template provided in the submission system. As proposals under this topic are expected to include clinical studies, the use of the template is strongly encouraged.

[1] As defined by the World Bank, https://www.worldbank.org

[2] https://www.gacd.org

[3] https://iris.who.int/bitstream/handle/10665/91758/9789241506212_eng.pdf

[4] In this context, non-healthcare settings can include for instance: workplaces; schools, universities and other education venues (including pre-schools, nursery, etc.); faith-based communities, places of worship and traditional healers; recreation and sports clubs, fitness centres, swimming pools; prisons; communities (geographic and/or of identity) and families; community pharmacies; theatres, community spaces; retirement homes and care homes; homeless shelters; markets, malls, commercial settings; barbers, hairdressers and beauty salons; urban environments, parks, transportation (the list is not exhaustive).

[5] Research proposals might explore implementation, outcomes and impact of context relevant strategies to implement evidence-based interventions or initiatives including (though not limited to):i) Non-health sector policy introduction, to tackle relevant social and/or structural determinants of NCDs; ii) Strategies to expand screening for NCDs and their risk factors in community, school, workplace, faith-based settings (e.g. Human Papillomavirus - HPV screening, blood pressure monitoring, blood sugar testing); ii) Partnered strategies to prevent NCDs in the community (e.g. educational campaigns, changes to school or work environments, promotion/delivery of healthy food choice and diet, opportunities for increased physical activity, strategies to support tobacco cessation and alcohol cessation); iv) Cost effective, patient centred treatment and management of NCDs in the community (e.g. mental health support, community medicine purchasing clubs, self-management groups); v) Non-health sector policy introduction e.g. environmental policy or practices (e.g. improvements to transport systems, public infrastructure) and the potential co-benefits on health; vi) Digital interventions e.g. for patient or care giver support, such as use of Artificial Intelligence for Patient support or to promote prevention messages on Chronic Disease Risk Factors).

[6] Focus on populations facing extreme vulnerabilities, such as individuals or communities living in informal settlements, post-disaster settings, or in situations of homelessness is encouraged (though not required).

[7] The following types of proposals are not in the scope of this topic: i) proposals with the primary aim of informing the development and/or selection of an intervention for a given context, where the implementation component will be explored in a future project (i.e. standalone feasibility projects);ii) epidemiological cohorts; iii) etiological work, mechanistic, or epidemiological research, unless an essential component of a focused study to develop implementation research approaches; iv) clinical trials, validation studies, or intervention efficacy studies for a new or established pharmacological agent or behavioural intervention.

[8] Examples of frameworks include (this list is not exclusive): i) Consolidated Framework for Implementation Research (CFIR); ii) the context enhanced (RE-AIM) Reach, Effectiveness, Adoption, Implementation, Maintenance); iii) Practical Robust Implementation and Sustainability Model (PRISM) frameworks; iv) Framework for Developing and Evaluating Complex Interventions (MRC & NIHR).

[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC3731143 and https://pmc.ncbi.nlm.nih.gov/articles/PMC6779135

[10] The use of the term ‘racial or ethnic origin’ does not imply an acceptance of theories that attempt to determine the existence of separate human races.

[11] The use of the term ‘racial or ethnic origin’ does not imply an acceptance of theories that attempt to determine the existence of separate human races.

[12] Please note that the definition of clinical studies (see introduction to this Work Programme part) is broad and it is recommended that you review it thoroughly before submitting your application.