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

Objective

The relentless rise in diabetes is one of the greatest global health emergencies of the 21st century. The increase is most pronounced in low and middle income countries where today three quarters of people with diabetes live and over 80% of the deaths attributed to non-communicable diseases occur. In light of the wealth of knowledge already available about how to tackle the problem, most major international organizations call for the adoption healthy public policies and initiatives to strengthening health systems. However, implementation of recommended action remains limited in many settings. Most evidence comes from high-income settings and may generate recommendations that cannot be successfully implemented in other settings without careful consideration and contextualization. I propose here that this “know-do” gap can be reduced by revealing the barriers to implementing evidence-based recommendations, engaging local stakeholders in developing context-led innovations and developing a tool-kit for contextualizing and implementing diabetes recommendations in low-resource settings. I plan the research in two carefully selected settings in Ecuador, with mixed-methods combining quantitative epidemiological research and qualitative methodology to generate the rich and varied knowledge that is required to trigger policy action and/or changes in care models. Furthermore, I will engage patients, community members, health workers and decision makers in the process of knowledge generation, interpretation and use. The overarching objective is hence, to explore the process by which global recommendations can be translated into context-specific, evidence-informed action for diabetes prevention in low-resource settings. The findings will support the global endeavour to bridge the global “know-do” gap, one of the most important public health challenges this century and a great opportunity for strengthening health systems and achieving health equity.