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Formative phase |
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Macro-level: Context analysis |
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1a |
What is the current strategy, capacity and engagement of stakeholders to scale-up the ICP and what is the societal and health system context that are potential barriers or facilitators to scale-up? |
Current strategy and plans to scale-up ICP; national context/health system barriers and facilitators |
Study specific semi-structured interview guide |
Indepth interview and document analysis |
1b |
Who are the key stakeholders in the scale-up? |
Stakeholder mapping and power and interest analysis |
Guidelines for Conducting a Stakeholder Analysis |
Indepth interview and document analysis |
1c |
What is the financing system for ICP? |
Financing system for ICP |
Topic guide on health and diabetes financing |
Key informant interviews, policy and administraion documents, related studies national health accounty |
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Meso-level: Analysis of current ICP implementation and cost |
Analysis of current ICP implementation and cost |
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1d |
What is the present implementation of the ICP and (variation in) organisational models in the current pilot sites |
Implementation of the ICP; organisational models and organisation context |
ICP implementation assessment grid; focus group discussion guide |
researcher observation and interviews in selected pilot sites |
1e |
What are the costs of implementing the ICP from the health system and health provider perspective |
Provider-side costs of ICP |
Study specific costing tool |
national health accounts and health insurance data (Slov/Bel), existing lit, rapid health facility survey (Cam) |
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Micro-level: individual outcomes |
Outcomes at individual level |
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1f |
What are the outcomes of the ICP as currently implemented |
Number of people with T2D/HTN; Proportion of people tested/diagnosed/retained in care/on treatment/followed-up/well controlled |
Cascades of care, starting from prevalence in reference year. |
household survey (Cam), combination of databases from insurance, laboratories and primary care networks (Slo,Bel) |
1g |
What is the cost for the patient and what are barriers to care? |
Patient side barriers to care; patient out of pocket expenditure |
Study specific demand side costing tool |
qualitative through focus group and indepth interview with patients; quantitative through patient diaries for sample of patients through population based survey |
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Intervention phase: scale-up strategy and implementation |
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Roadmaps |
Scale-up strategy |
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2a |
How can we, in co-creation with stakeholders, optimize the current Scale-Up (S-U) strategy |
Recommendations for improved scale up |
Policy dialogues and roadmaps |
Formative findings study 1–3 |
2b |
Which mechanisms can be identified for the relationship between scale-up strategy, actors and context? |
Empirical and theoretical evidence |
Scientific enquiry |
dialogue practice and theory, implementors and researchers |
2c |
What is the minimum indicator set to monitor |
minimum monitoring data set |
quantitative data on CoC; qualitative data on process, barriers and context |
survey statistics extracted from routine data; observations, key information interviews, patient interviews, project documents |
2d |
What are the projected cost for different scenarios |
projected cost |
costing models |
Formative findings study 1–3 |
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Evaluation phase: outcome and impact evaluation |
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3a |
How has the roadmap been implemented and to what extent, and how is the context influencing the implementation of the scale-up strategies, including cost |
implementation of the roadmap |
Reach (Number of scaleable units covered by the scale-up); Acceptability (measured by Affective Attitude, Burden, perceived effectiveness, Opportunity Costs, Intervention Coherence, implementors’ Self-efficacy, and Ethicality) and feasibility of the scale-up strategy (measured by adaptation and fidelity of implementation) |
project diaries, interviews with implementors and key informant interviews |
3b |
What is the progress on each of the three axes of the scale-up box |
progress on (a) the population coverage(b) the expansion of the ICP (c) integration |
(a) reach; target population living in area; number of people actually covered by intervention (b) number of components added to the ICP (c1 organisation level, ICP implementation grid see 2) normalisation process theory (c2health system level) sustainable financing arrangements for the ICP, provider payment mechanisms stimulate health education and self-management, human resource planning for teamwork in facilities and with community, care pathways, common monitoring |
Quantitative data through routine data or population survey. Qualitative data at endline through project diaries, interviews with implementors, and key informant interviews and practice |
3c |
What is the impact of the scale-up on the control of T2D and HT ? |
impact of the scale-up on the control of T2D and HT |
CoC (see 3) |
Interrupted timeseries from routine data |
3d |
What are the costs of the scaled-up ICP, for the health system and for the patient? |
costs of the scaled-up ICP: (a) health system and (p) patient perspectove |
(a) cost of human resources and service delivery (b) out of pocket expenditure (see 3) |
(a) primary qualitative and quantitative data (b) patient survey |