Research Projects
Synopsis of completed research projects
Effectiveness of national strategies for non-communicable diseases

Effectiveness of national strategies for non-communicable diseases

Research area: Prevention and screening

Project team: Lucia Gassner, Inanna Reinsperger

Duration: April 2021 – November 2021
Language: English with German summary
Suggested by: Federal Ministry of Social Affairs, Health, Care and Consumer Protection

Publication: HTA Project Report No. 139: https://eprints.aihta.at/1349/

Background: Non-communicable diseases (NCD) are conditions that include, e.g., diabetes, cardiovascular diseases, cancer, chronic respiratory diseases, and mental disorders. These diseases account for 86 per cent of all deaths and 77 per cent of disease burden in the WHO European Region [1].

Many western countries apply strategies to prevent and manage NCDs in order to improve the care for chronically ill people and extend the number of healthy life years (HLY), i.e., the number of years that a person is expected to continue to live in a healthy condition (without limitation in functioning and disability) [2]. The ten Austrian health targets, developed in 2012, aim to prolong the HLY of all people living in Austria within 20 years [3]. Austria significantly lags behind other countries in terms of healthy life years: In 2019, the number of HLY at birth was estimated at 58 years for women and 56.7 years for men in Austria. In contrast, the mean number of HLY in the European Union is 65.1 for women and 64.2 for men [4].

Therefore, the question arises which national strategies to prevent and manage NCDs are used in different countries and which specific interventions/programmes are implemented and evaluated. The analysis focuses on diabetes type II, cardiovascular diseases, chronic respiratory diseases, and depression.

Aim of the project: The project aims

to provide an overview of national strategies for preventing and managing NCDs (diabetes type II, cardiovascular diseases, chronic respiratory diseases, depression) in selected (Western industrialised) countries and their implementation, and
to summarise evaluation results for specific programmes/interventions/measures of the identified national strategies concerning the mentioned NCDs.

Research questions (RQ): The following research questions will be answered:

RQ1: Which national strategies/policies (at a macro level) are in place in Western industrialised countries in relation to the aforementioned NCDs and their risk factors?

RQ2: What information is available on the implementation and implementation process? Which specific programmes/interventions/measures (at a micro level, e.g., disease management programmes) are described in the national strategies?

RQ3: Which evaluation results of these programmes/interventions/measures (e.g., on implementation, effectiveness) can be summarised?

Methods: These three research questions will be answered using the following methods:

RQ1: Mapping of national strategies (at a macro level) in Western industrialised countries in relation to the above mentioned NCDs and their risk factors

Systematic hand search for national strategies/policies addressing the four NCDs mentioned above (e.g. in PubMed, Google Scholar, TRIP database, WHO, OECD, websites of ministries of health and public health institutions)
If applicable, contacting experts to identify relevant national strategies
Tabular presentation and description of the identified national strategies on country level (e.g. title, year, indications, focus [prevention, management], objectives)

RQ2: Information on the implementation (process) and specific programmes/interventions/measures (at a micro level, e.g., disease management programmes) of the national strategies identified in RQ1

Analysis of the national strategies (and, if applicable, further documents) concerning information on the (planned) implementation (process) (e.g. time frame, actors involved, organisational framework, monitoring) and tabular presentation
Tabular presentation and description of the specific programmes/interventions/measures mentioned in the national strategies (e.g. target groups, professional groups involved, setting, programme content, duration/scope of the intervention, objectives)
Preparation of a ‘shortlist’ (selection) of potentially relevant programmes/interventions/measures by country, which will be analysed in more detail in the context of RQ3

RQ3: Evaluation results of the programmes/interventions/measures

Targeted country-specific hand search for evaluation reports and/or published studies on the programmes/interventions/measures selected in the ‘shortlist’
If applicable, contacting relevant experts (from ministries, etc.) to identify relevant evaluation reports
If applicable, systematic (country-specific) search for evaluations of measures
Assessment of the evaluation reports’ quality using Risk of Bias tools (depending on the study design)
Data extraction and synthesis

Inclusion criteria for relevant evaluation reports (RQ1+2)

Description	Project scope
Type of publication	National strategies and policies, which address one of the four NCDs (diabetes type II, cardiovascular diseases, chronic pulmonary/respiratory diseases, depression)
Outcomes	main characteristics (e.g., title, year, indications, focus, aims) information on the (planned) implementation process (e.g., time frame, involved stakeholders, organisational framework conditions, monitoring) specific programmes/interventions/measures (e.g., target groups, professional groups involved, setting, programme content, duration/scope of intervention, aims)
Settings	Western industrialised countries (Europe, North America, Australia, New Zealand)
Languages	English, German

Inclusion criteria for relevant evaluation reports (RQ3)

Description	Project scope
Intervention	Specific programmes/interventions/measures (e.g., Disease management programme [DMP], Case management, Prevention programme) for adults suffering from one of the four NCDs (diabetes type II, cardiovascular diseases, chronic pulmonary/respiratory diseases, depression) or adults with risk factors of these diseases not: measures of control and design outside the health care system (e.g., taxation of sugary drinks)
Outcomes	Effectiveness outcomes (e.g., mortality, morbidity, hospitalisation, quality of life, health care utilisation, patient satisfaction, symptoms improvement) Implementation outcomes (e.g., implementation status, achievement of programme targets, acceptance)
Study design	Evaluation studies, reports and published studies
Settings	Western industrialised countries (Europe, North America, Australia, New Zealand)
Languages	English, German

The workflow is organised according to the principle of dual control (LG, IR), and the results are subject to internal and external reviewers.

Schedule/milestones

Period	Tasks
April 2021	Scoping, project protocol
May to June 2021	RQ1: Systematic hand search for strategies/policies If applicable, contacting experts Tabular presentation and description of identified national strategies at country level Milestone 1: Table of national strategies at country level
June to July 2021	RQ2: Analysis of the national strategies concerning the implementation process Tabular presentation/description of specific programmes/interventions mentioned in the strategies Shortlist (selection) of potentially relevant programmes/interventions by country Milestone 2: ‘Shortlist’ of specific programmes/interventions
July to September 2021	RQ3: Targeted country-specific hand search for evaluation reports on the selected programmes/interventions If applicable, contacting experts Quality assessment of evaluation reports, data extraction and synthesis Milestone 3: Table of evaluation results of specific programmes/ interventions by NCDs
October 2021	Finalisation of the report, internal and external review
November 2021	Layout and publication of the report