Contextualizing Evidence for Action on Diabetes in low-resource Settings: A mixed-methods case study in Quito and Esmeraldas, Ecuador.

Project Information

CEAD

Grant agreement ID: 804761

DOI

10.3030/804761

Project closed

EC signature date 21 November 2018

Start date 1 January 2019

End date 30 September 2024

Funded under

• EXCELLENT SCIENCE - European Research Council (ERC)

Total cost

€ 1 475 334,00

EU contribution

€ 1 475 334,00

Coordinated by

UNIVERSIDAD MIGUEL HERNANDEZ DE ELCHE
Spain

Periodic Reporting for period 4 - CEAD (Contextualizing Evidence for Action on Diabetes in low-resource Settings: A mixed-methods case study in Quito and Esmeraldas, Ecuador.)

Reporting period: 2023-07-01 to 2024-09-30

Summary of the context and overall objectives of the project

Diabetes is a growing global health challenge, particularly in low-resource settings where health systems often struggle to deliver effective prevention and care. Despite global recommendations for diabetes management, their implementation is frequently hindered by a lack of context-specific, actionable strategies. The CEAD project set out to address this gap by contextualising diabetes prevention and care in under-researched, low-resource areas, using two regions in Ecuador—Esmeraldas and southern Quito—as case studies.

This issue is critically important for society as diabetes and other non-communicable diseases (NCDs) are leading causes of ill health and death worldwide, with the burden disproportionately affecting vulnerable populations. Addressing diabetes through locally tailored, evidence-based strategies not only improves individual health outcomes but also strengthens community resilience and reduces the strain on overburdened health systems.

The CEAD project aimed to bridge the gap between global recommendations and local realities by generating evidence on diabetes risk and prevalence, analysing the contextual relevance of public health policies, and co-designing innovative strategies with communities to improve diabetes prevention and care. The project emphasised participatory approaches to foster local ownership and sustainability, creating practical resources such as infographics and policy briefs to support education, advocacy, and decision-making. Through these efforts, CEAD has contributed to advancing health equity and providing a framework for addressing similar health challenges in other low-resource settings.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

The CEAD project addressed the critical challenge of adapting global recommendations for diabetes prevention and care to low-resource settings, focusing on two diverse regions in Ecuador: Esmeraldas and southern Quito. Over the course of the project, we combined rigorous research, participatory methodologies, and innovative communication tools to generate context-specific insights and strategies for improving health outcomes in under-resourced communities.
A cornerstone of the project was the generation of comprehensive data on diabetes and related risk factors through population surveys and health system analyses. This work revealed significant disparities, particularly in gender and access to care, highlighting the unique challenges faced by marginalised populations. Importantly, the project emphasised translating findings into practical tools and actions, such as infographics, policy briefs, and community-driven initiatives, ensuring that the results could inform health promotion, education, and decision-making.
Participatory processes were central to our approach, engaging local stakeholders—including healthcare providers, patients, and community members—to co-design solutions tailored to their specific contexts. From workshops to examine the role of social support in diabetes care to storytelling workshops and community food gardens, these activities fostered local ownership and generated knowledge about how to promote sustainable health system improvements in these low resource settings.
The project has resulted in several publications in important open-access journals, ensuring the findings are freely available to a broad audience, and we have presented the results at different national and international conferences. The findings have also been shared in a series of public engagement workshops and events to promote wider discussion of the research and its implications, helping to maximise the social impact of our work. These achievements demonstrate the importance of collaborative, context-sensitive approaches to addressing health inequities and provide valuable lessons for tackling similar challenges in other low-resource settings.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The CEAD project has contributed valuable knowledge to advance understanding of how to adapt global recommendations for diabetes prevention and care to low-resource settings. By analysing barriers such as limited resources and social inequities in regions like Esmeraldas and southern Quito, the project has generated insights that encourage further reflection on the need to move beyond generic global guidelines. This work emphasises the importance of tailoring health strategies to specific contexts, fostering more equitable and effective healthcare delivery.
The project has achieved significant milestones that extend beyond its initial objectives, including establishing a strong foundation for participatory public health research in Ecuador. By integrating rigorous epidemiological studies with qualitative and community-driven methods, CEAD has created a framework for contextualising health innovations. Its outputs highlight a commitment to fostering local ownership, building international collaborations, and addressing health inequities through innovative and context-sensitive approaches.
Through participatory methodologies, CEAD engaged local stakeholders to co-create context-specific strategies, ensuring that proposed solutions align with the realities of the communities involved. The project’s innovative use of communication tools, such as infographics and policy briefs, made complex data more accessible, reframing findings positively to emphasise healthy behaviours and foster constructive dialogue.
Additionally, CEAD’s intersectional analysis of gender, ethnicity, and socioeconomic factors has provided a deeper understanding of the social determinants of health, highlighting disparities often overlooked in traditional research. Moving forward, the project will continue to disseminate its findings through open-access publications, policy briefs, and public engagement activities, contributing to long-term efforts to address health inequities and improve resilience in low-resource settings.

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