A new research centre will test whether four low-cost, community-based interventions—including peer support groups and volunteer befriending—can improve care for people with long-term conditions across Latin America. Non-communicable diseases such as heart disease, diabetes, and mental health disorders are the leading causes of death worldwide, and their burden falls hardest on low- and middle-income countries with limited healthcare resources. Most existing treatments require expensive specialist care, leaving millions without effective support. This centre focuses on interventions that can be delivered by non-specialists in community settings, making them accessible even in remote or resource-poor areas. If the trials succeed, the centre will provide evidence that governments and health organisations across Latin America can use to redesign how they manage chronic conditions. The research specifically includes indigenous communities, whose perspectives are often absent from health policy. A stepped-wedge trial design ensures every participating hospital eventually receives the intervention, maximising direct benefit to patients. Beyond the region, the findings could influence community healthcare models worldwide, potentially improving outcomes for millions of people living with long-term conditions.
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Background: Non-communicable diseases (NCDs) including cardiovascular disease, diabetes, chronic respiratory conditions and mental health disorders, are leading causes of morbidity and mortality worldwide. Their impact is greatest within Low and Middle Income countries, where healthcare resources are limited. There is a need to develop low-cost approaches that can be easily implemented within the community to improve patient outcomes. Aims and Objectives: Our aim is to develop a world-class Centre with a regional focus in Latin America, to strengthen research and service capacity, conduct high quality research and improve quality of life and disease specific outcomes for individuals with long-term NCDs, including those from indigenous communities. The Centre will combine innovative research studies with a comprehensive capacity strengthening strategy aimed at developing a critical mass of researchers. Methods: Three core research themes will produce evidence to improve the community-based care of long-term conditions, and provide real-world research experience to implement the capacity strengthening strategy. At the core of the research are four low-cost, evidence-based resource-orientated interventions - DIALOG+, multi-family groups, peer support and volunteer befriending. Workshops, small-scale pilots, ethnographic case studies and focus groups with different stakeholders, specifically including indigenous communities, will shape the interventions. We will then test effectiveness and implementation in two large-scale hybrid II stepped-wedge trials, focusing on physical health and mental health respectively. Stepped-wedge trials offer a pragmatic, efficient and innovative design, overcoming many of the limitations of parallel trials and ensuring all services receive the intervention thus maximising benefit. For each trial, 9 hospitals and 216 participants (per country) will be recruited and sequentially randomised to the intervention, with outcomes measured at 6,12 and 18 months. A separate research theme will prioritise the perspectives of individuals from indigenous communities. Participatory, ethnographic and arts-based methods will explore access and engagement with community-based healthcare. Finally, running alongside the research is a comprehensive capacity strengthening strategy including workshops, seminars, residential research placements and a formal training programme of PhDs and Masters Degrees. Impact and Dissemination: The Centre will develop and maintain close links with local communities to ensure our research is priority-driven. We will consult advisory groups including individuals with long-term NCDs, family members, indigenous community leaders, clinicians and government representatives to ensure we remain responsive to local need. Activities will be widely disseminated through scientific and non-scientific publications, social media and via an interactive website. Participatory approaches will co-produce materials, performances, and events to reach community members that traditional academic dissemination activities often fail to engage. If successful, the knowledge produced will strengthen the capacity of healthcare and research organisations across Latin America. Beyond this, the learning generated, has the potential to influence and strengthen community healthcare, hence improving outcomes for millions of people with long-term NCDs worldwide.
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