DiabetesHypertensionScale Up SU11, 2019 – 2024

Scaling up the Community Health Assessment Program in the Philippines (CHAP-P)

Background

High blood pressure and diabetes are leading risk factors for morbidity and mortality worldwide, with particularly strong prevalence in low- and middle-income countries (LMICs), where awareness, diagnosis, and treatment are also poorer. Showing consistent results of improving cardiovascular outcomes in Canada, the Cardiovascular Health Awareness Program (CHAP) was adapted to the Philippines, an LMIC, as the Community Health Assessment Program in the Philippines (CHAP-P). CHAP-P is a community-based, volunteer-led cardiovascular/diabetes risk assessment and blood pressure monitoring program with health education sessions.

The current study aims to assess the scalability of CHAP-P across an entire Administrative Region of the Philippines, Region IX, Zamboanga Peninsula (population: 3.6 million, 67 municipalities and 4 cities). The study will identify factors and processes affecting acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, cost-effectiveness, penetration, and sustainability of CHAP-P; and develop tools to further scale-up CHAP-P nationally and in similar LMICs. The proposed implementation science approach will integrate several components: the Knowledge-to-Action Framework, to be used as a process model to guide planning and implementation; combined use of the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) as implementation theories to help understand and explain influences on implementation outcomes at the community (CFIR) and individual (TDF) levels; and development of a program logic model to outline our program theory.

There will be 3 main stages of research implementation: 1) Scale-up strategic planning, involving stakeholders across all levels to plan the best way to scale-up CHAP-P region-wide; 2) Implementation and quality improvement, where the program will be implemented and best practices learned from early adopters will be integrated into the program; and 3) Research evaluation and knowledge translation. Stage 3 will also include readiness assessments in selected partner countries (to potentially include Thailand, Tunisia, and Peru). This proposal meets all objectives of the current opportunity. It enhances scale-up of the evidence-based CHAP intervention aimed at prevention/detection and management of hypertension and diabetes in the Philippines, an LMIC. It develops strategies to overcome barriers and enhance facilitators by including a multidisciplinary/cross-sectoral team of lay health workers, health professionals, government officials from various levels, citizens, and researchers.

Finally, it creates new knowledge on how to appropriately adapt CHAP-P, taking into consideration the different geographic, economic, and cultural factors in the Zamboanga Peninsula include rurality and geographic isolation, poverty, and a diverse set of languages and religions, learning which can then be applied nationally and to other LMICs.

Programme Team

  • Gina Agarwal McMaster University
  • Ricardo Angeles McMaster University
  • Fortunato Cristobal Ateneo de Zamboanga University, Philippines
  • Lisa Dolovich University of Toronto
  • Janusz Kaczorowski University of Montreal; University of Montreal Research Centre
  • Joshua Brillantes Department of Health Regional Office
  • Cheryl R. Sarmiento Department of Health Regional Office
  • Vincent Y. Jr. Belizario University of the Philippines Manila
  • German Malaga Universidad Peruana Cayetano Heredia
  • Elgie Gregorio Ateneo de Zamboanga University, Philippines
  • Lynda Redwood-Campbell McMaster University
  • Karl Stobbe McMaster University
  • Lehana Thabane McMaster University
  • Dale Guenter McMaster University
  • Hilton Lam University of the Philippines
  • Norvie Jalani Zamboanga City Medical Center
  • Jerome Barrera Ateneo de Zamboanga University, Philippines
  • Servando Jr. Halili Ateneo de Zamboanga University, Philippines
  • Rosemarie Arciaga Ateneo de Zamboanga University, Philippines
  • Jerald Ramos Mahayag Municipal Hospital
  • Reiner Alonzo Manuka Rural Health Unit
  • Eduardo Luayon Province of Zamboanga del Norte Provinical Hospital
  • Roman O Blancia, Jr. Province of Zamboanga del Sur
  • Pattapong Kessomboon Khon Kaen University
  • Nusaraporn Kessomboon Khon Kaen University
  • Faical Jarraya Hopital Hedi Chaker
  • Augusto Manolo Alpichi Zamboanga Sibugay Department of Health
  • Ulysses Silorio Integrated Provincial Health Office
  • Dulce Amor Dagalea-Miravite Zamboanga City Health Office
  • Rex Samson Sindangan Rural Health Unit
  • Carmel Mathilda B. Ladeza Tampilisan Rural Health Unit
  • Sitti Nurussamsi Amilasan Basilan General Hospital
  • Michael Site Diplahan Municipal Hospital

Funding organisations

  • DiabetesHypertensionScale Up SU11
  • Philippines
  • 2019 – 2024

Programme contact
Gina Agarwal
agarg@mcmaster.ca