Table 3.
Summary of overarching themes, supported by subthemes and first-order codes to describe the scope and content of the strategies outlined in the included policies. Frequencies of general strategies and frequencies of specific strategies relevant to musculoskeletal (MSK) health, pain or mobility/functional ability, by policy, are included to provide a measure of prominence for first-order codes. Frequencies are colour coded for ease of interpretation (red <25%; amber ≥25% to <50%; green ≥50%).
| Subthemes | First-order codes describing strategies contained in policies | Frequency of policies with general strategies; n (%) | Frequency of policies with strategies relevant to MSK, pain or mobility/functional ability care; n (%) |
| Theme 1: General principles for people-centred NCD care | |||
| 1.1 NCD prevention and management across the life course | 1.1.1 NCD prevention/management should be based on a care continuum across the life course from prevention (including maternal and child healthcare) through to rehabilitation and palliative care that is tailored to the individual's needs and that considers physical health, mental well-being and injury protection. A focus on vulnerable groups should be prioritised. | 16 (38.1)* | 8 (21.1) |
| 1.1.2 NCD prevention/management should include initiatives that address social and financial consequences of, or risk factors for, NCDs and that promote physical and social function. | 13 (31.0)* | 8 (21.1) | |
| 1.1.3 NCD management should adopt a people-centred model in service delivery. | 1 (2.4)* | 2 (5.3) | |
| 1.2 Promoting healthy behaviours, safe environments and reducing risk | 1.2.1 NCD prevention/management should be based on promoting a healthy and safe environment to minimise risk factors for NCDs including food safety, exposure to chemicals, air and noise pollution, and climate change. This approach should extend to education and work environments. | 15 (35.7) | 3 (7.9) |
| 1.2.2 NCD prevention/management should support the development and implementation of multifaceted interventions to increase the volume of physical activity (PA) and reduce sedentary behaviour at the population level targeting all ages (eg, population awareness campaigns; supportive environments and transport options; work and school-based PA; leadership in PA initiatives; upskilling teachers in PA) with indicators to monitor performance. | 14 (33.3)* | 16 (42.1) | |
| 1.2.3 NCD prevention/management should be based on promoting healthy behaviours/lifestyles to minimise risk factors for NCDs (primary and secondary prevention) with a strong focus on obesity management. Foci should include healthy lifestyle (nutrition focusing on a reduction of sugar, salt and saturated fats; PA; safe use of alcohol/tobacco; minimising substance abuse especially in youth; mental health strategies; and oral hygiene). This approach should extend to education and work environments, with particular attention paid to supporting healthy lifestyle environments for children in schools. | 30 (71.4)* | 22 (57.9) | |
| 1.2.4 NCD prevention/management should include public health education that is accessible and disseminated across various settings (eg, work, education/school, kindergarten) and is tailored to target groups, with the outcome being a change in health beliefs and empowering positive health behaviours (improved health literacy) and improved capacity for self-management. In some settings, mass media is recommended. | 25 (59.5)* | 17 (44.7) | |
| 1.2.5 †NCD prevention/management should support the development and implementation of policies and/or programmes that target reducing the potentially negative effects of alcohol, narcotics, doping substances and tobacco (ANDT) on the MSK system, on the mental health system and that reduce the chances of injury to the MSK system. | – | 2 (5.3) | |
| 1.3 Effective partnerships to support people-centred care | 1.3.1 NCD prevention/management efforts (inclusive of service delivery, service design and policy formulation) should be approached with effective partnerships across the sector (eg, government, civil society, volunteers, health services, industry) and with consumers and their families, including indigenous communities. | 21 (50.0)* | 11 (28.9) |
| 1.4 Research to support people-centred NCD care | 1.4.1 NCD prevention/management should support research that is accessible to decision makers, that addresses societal need in NCD prevention/management, that considers emerging technologies/technology innovations, that examines the value of complementary and alternative medicines, and is system-relevant. | 12 (28.6)* | 7 (18.4) |
| Theme 2: Service delivery | |||
| 2.1 Improving care quality, safety and consumer satisfaction | 2.1.1 Deliver interventions or services that are effective and safe (high-value) and that improve care quality and consumer satisfaction. | 15 (35.7)* | 7 (18.4) |
| 2.1.2 Prevention initiatives (eg, programmes, policies) should be underpinned by quality criteria for NCD prevention, including evaluation of effectiveness. | 4 (9.5)* | 4 (10.5) | |
| 2.2 Early intervention | 2.2.1 NCD prevention should include timely interventions to identify and manage risk factors, enable early diagnosis (eg, health checks, screening, education campaigns) and enable risk classification/stratification. | 20 (47.6)* | 14 (36.8) |
| 2.2.2 †National health assessments or ‘health checks’ should include assessment of disability. | – | 1 (2.6) | |
| 2.2.3 †Implement strategies and policy for injury prevention at work, for leisure and sport and that monitor injury prevalence. | – | 3 (7.9) | |
| 2.3 Programmes targeting condition-specific NCDs | 2.3.1 NCD management of major conditions should include programmes that are evaluated and supported by disease-specific clinical guidelines and established criteria for diagnosis and stratification. Mechanisms to update programmes based on new evidence should be included. | 8 (19.0)* | 3 (7.9) |
| 2.3.2 NCDs management should include disease-specific and technology-enabled models of care, that address a specific population or condition/disease group and contain evidence-based components of care, implementation strategies, and mechanisms for monitoring and quality improvement. | 4 (9.5)* | 2 (5.3) | |
| 2.3.3 †NCD management should include support strategies for obesity reduction/prevention strategies, in addition to general nutrition and PA strategies. | – | 1 (2.6) | |
| 2.3.4 †Support delivery of mental healthcare through targeted health promotion, through accessible services (inclusive of mind-body therapies) and through provider training in mental healthcare. | – | 5 (13.2) | |
| 2.3.5 †Support specific system and service strategies for arthritis (identification of disease, supporting adherence to pharmacological and non-pharmacological care, integrated management between health services and clinicians, development of models of service delivery and models of care). | – | 2 (5.3) | |
| 2.4 Improving access to NCD care | 2.4.1 Support NCD management by harnessing digital technologies (eg, eHealth, telehealth, electronic medical records) to enable information/service access and exchange for consumers and health professionals to support self-management, system navigation and care delivery. | 10 (23.8)* | 6 (15.8) |
| 2.4.2 Support accessible NCD care services (geographically accessible, appropriate infrastructure, ICT support) irrespective of age, gender, residence and socioeconomic status, and ensure that services are culturally acceptable. | 17 (40.5)* | 12 (31.6) | |
| 2.4.3 NCD prevention and management needs to be supported by population access to essential medicines and essential laboratory medicine. | 3 (7.1)* | 4 (10.5) | |
| 2.5 Care coordination and integration | 2.5.1 Create community-based, multidisciplinary healthcare teams responsive to local needs, supported by a referral network for providers. | 5 (11.9)* | 4 (10.5) |
| 2.5.2 Build and monitor capacity/competencies in the workforce (particularly in primary care) to deliver high-value NCD care, including a focus on ageing, mental health, obesity management, PA and competencies in technology use. | 17 (40.5)* | 10 (26.3) | |
| 2.5.3 Support care coordination between the workforce and support coordination and integration between services, regions and existing programme (eg, with ICT infrastructure, referral networks). | 20 (47.6)* | 11 (28.9) | |
| 2.5.4 †Ensure that health facilities have rehabilitation professionals working in multidisciplinary teams. | – | 1 (2.6) | |
| 2.5.5 †Ensure that citizens who have NCDs have comprehensive health plans developed, inclusive of supports for return to work. | – | 3 (7.9) | |
| 2.5.6 †Support the provision of community-based rehabilitation services, especially in areas where care disparities exist. | – | 2 (5.3) | |
| 2.6 Supporting healthy ageing | 2.6.1 In the context of supporting older people living with NCDs, implement specific strategies and indicators to support healthy ageing (health promotion; health checks; interventions to address functional impairments; develop models of care for older people that include geriatric care and long-term care systems). | 8 (19.0)* | 5 (13.2) |
| Theme 3: System strengthening | |||
| 3.1 Capacity for emergency response to disasters and epidemics | 3.1.1 Strengthen emergency response capacity to better manage disasters and epidemics. | 5 (11.9)* | 1 (2.6) |
| 3.2 Population health monitoring and performance | 3.2.1 To inform NCD prevention and management initiatives, population health monitoring/surveillance is needed through electronic health information systems, that should include health and injury outcomes and the social determinants of health. | 14 (33.3)* | 6 (15.8) |
| 3.2.2 Performance targets for NCD management/prevention should be based on: reduction in risk factors for NCDs; prevention of premature mortality; minimising morbidity (reduce disability and increase healthy life years); reduction in disease incidence; reduction in cost associated with NCDs; reduction in care disparities and health inequalities due to financial or social factors in vulnerable groups (eg, indigenous groups, ethnic minorities); and empowerment of citizens to more actively manage their health/participate in their healthcare. | 23 (54.8)* | 9 (23.7) | |
| 3.3 National care standards and reporting | 3.3.1 Establish national care/quality standards and standardised reporting for NCDs, care delivery and health outcomes to enable monitoring of care quality. | 8 (19.0)* | 6 (15.8) |
| 3.3.2 †Develop care guidelines/quality standards relevant to the care of people with MSK conditions (eg, rehabilitation guidelines; disability guidelines; community health promotion guidelines that include PA, nutrition, injury prevention and mental health). | – | 1 (2.6) | |
| 3.4 Financing to support NCD care | 3.4.1 Financing for NCD care needs to consider long-term health spending, resources to support implementation of policy/programmes, compulsory insurance, funding only interventions and technologies with proven effectiveness, universal health insurance, and payments linked to performance and quality. | 11 (26.2)* | 7 (18.4) |
| 3.4.2 †Appropriately finance rehabilitation services to ensure appropriate quality care can be delivered sustainably. | – | 1 (2.6) | |
| 3.4.3 †Provide social and financial support packages for people living with disability and/or their carers. | – | 1 (2.6) | |
| 3.5 Policy and regulation | 3.5.1 Ensure health, especially NCD prevention/management, is considered in all public policy and interministerial activity (eg, social policy, ageing policy, employment policy), including the evaluation of policies in terms of health impact. | 12 (28.6)* | 6 (15.8) |
| 3.5.2 NCD prevention and management should be nationally prioritised agenda items. | 1 (2.4)* | 0 (0) | |
| 3.5.3 NCD prevention and management requires strengthening of health governance through the formulation of appropriate health and social policies. These should be evidence-based, enable monitoring of outcomes that are aligned to international targets, address the needs of people with disability and support citizens to actively and positively manage their health. | 9 (21.4)* | 5 (13.2) | |
| 3.5.4 Develop and implement financial and marketing regulation and/or policy measures to support citizens make healthy choices and limit unhelpful commercial influences on health behaviours and outcomes (eg, nutritional information for food, making healthy food affordable, regulation of advertising unhealthy foods, regulation of sales of illicit drugs via social media, tobacco control). | 14 (33.3)* | 4 (10.5) | |
*Strategies relevant to the prevention/management of musculoskeletal health conditions, persistent pain or loss of functional ability/mobility.
†Additional codes added where strategies were specifically related to persistent pain or mobility/functional ability care.
ICT, information and communication technology; MSK, musculoskeletal; NCD, non-communicable disease; PA, physical activity.