Core health-components, contextual factors and program elements of community-based interventions in Southeast Asia: a realist synthesis regarding hypertension and diabetes

Zinzi E. Pardoel*, Sijmen A. Reijneveld, Robert Lensink, Vitri Widyaningsih, Ari Probandari, Claire Stein, Giang Nguyen Hoang, Jaap A. R. Koot, Christine J. Fenenga, Maarten Postma, Johanna A. Landsman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background

In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia.

Methods

A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements.

Results

We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice.

Conclusions

We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context.

Original languageEnglish
Article number1917
Number of pages14
JournalBMC Public Health
Volume21
DOIs
Publication statusPublished - 22-Oct-2021

Keywords

  • Community-based interventions
  • Southeast Asia
  • Non-communicable diseases
  • Diabetes
  • Hypertension
  • Core health-components
  • Contextual factors
  • Program elements
  • Realist synthesis
  • review
  • SELF-MANAGEMENT
  • SUPPORT
  • PREVENTION
  • COUNTRIES
  • QUALITY

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