From research to the real world: How implementation science can drive NCD action

This blog was originally published on the Global Alliance for Chronic Disease Website and is reproduced here with due permissions.

This blog highlights key insights from a parallel session led by The Global Alliance for Chronic Diseases (GACD) in collaboration with The George Institute for Global Health (TGI) at the 4th Global NCD Alliance Forum, held in Kigali, Rwanda, from 13-15 February 2025. The session, “Knowledge isn’t power without implementation – the science behind translating community know-how into lasting change”, focused on practical strategies to bridge the gap between research and practice, emphasising how community-engaged implementation research can drive lasting change. Experts, including Bindu Patel, Josephine Birungi, Stephen Watiti, Deepika Saluja and Shabbar Jaffar, shared first-hand perspectives on the impact of collaboration in advancing this approach.

Despite groundbreaking research and proven healthcare interventions, the integration of these discoveries into routine practice takes an average of 17 years. This ‘know-do’ gap – where knowledge exists but is not translated into action – prevents not only life-saving treatments from reaching those in need but also delays the implementation of important public health interventions. From disease prevention and mental health support to addressing social determinants of health such as housing, nutrition, and environmental health, the gap hinders progress in building healthier societies.

Implementation science aims to bridge this gap by examining how to best integrate evidence-based solutions into real-world settings, unpacking the how, why and under what condition and by whom the programme, innovation, treatment, or policy will make a positive change to the health and wellbeing of individuals and communities.

Implementation science involves communicating research in ways that meet the needs of policymakers, healthcare providers, advocacy groups and importantly communities, for whom the research is being conducted in the first place.

Whether referred to as knowledge translation, knowledge utilisation, evidence-based medicine, or knowledge mobilisation, the goal is the same: getting the right information to the right people in the right format at the right time for timely and appropriate action. Through this approach, we gain a better understanding of how to collaborate with diverse stakeholders that will have different needs and perspectives and ensure that knowledge gained is used to inform our future research endeavours.

Different stakeholders require different types of information: academics need access to data for critical appraisal, policymakers need comprehensive insights for decision-making, and communities need research findings in plain language that respects cultural contexts. Without this, interventions often fail to make a lasting impact.

Communities are at the heart of change: knowledge on its own is not enough

One of the biggest barriers to successful implementation research is the lack of meaningful community engagement and involvement (CEI). Too often, patients and communities are not actively involved in defining research priorities or shaping interventions. By engaging communities prior to implementation – right from the early stages of conceptualisation of research to design, implementation and evaluation, we can ensure that the interventions are relevant across diverse communities that will make meaningful change in improving health and wellbeing.

Patients, carers, and the public have a right to be involved in what is being researched, how it is conducted, and to engage throughout the process as leaders and knowledge holders/users. Researchers must listen to communities, understand local contexts, and facilitate meaningful participation right from the outset.

Implementation research in action

The Fiji Ministry of Health and Medical services implemented the World Health Organisation (WHO) Package of Essential Noncommunicable (PEN) diseases programme from 2010-2019 and implementation science helped them to understand the processes of how the PEN programme worked within the Fiji health system. WHO PEN is a set of low-cost, evidence-based interventions designed to address major non-communicable diseases (NCDs) in primary care settings with limited resources. The programme was introduced in Fiji to address rising rates of high blood pressure, diet-related diseases, and obesity. The George Institute for Global Health in partnership with the Ministry of Health Medical Services and Fiji National University conducted a comprehensive evaluation on how the programme was implemented, how it is being used and what the patients think of the programme.

The research into PEN’s implementation has provided valuable insights into how it has been used by patients and healthcare staff, as well as shifts in patient understanding and awareness of NCD risk. However, some challenges persist that influenced the use of the programme by both healthcare providers and patients. The programme’s long-term effectiveness requires addressing the evidence from both patients and healthcare providers to address limitations in resources that hinder access and engagement of patients.

Another compelling case comes from the INTE-Africa project which integrated and scaled up diabetes and hypertension services with HIV services in Uganda and Tanzania (2019 – 2023). Stakeholders including community members and policy makers were engaged right from the beginning. During the initial dialogues policymakers from the Ministries of Health voiced their concerns about integration of care for communicable (HIV) and noncommunicable diseases (Diabetes and hypertension) including the HIV associated stigma, cost of implementation, negative effect on the already thriving HIV programme and workload.

They advised the researchers to start with a pilot study to develop and test the proposed integrated care model in a small number of primary health facilities before a large-scale roll out of the INTE-Africa project in 32 health centres.

Before the development of the proposal, researchers held discussions with patients living with HIV and/or NCDs to introduce the idea of integrated care and seek their perspectives and suggestions. The patients shared interesting and surprising views, for example that their greatest need was not so much the free drugs as researchers thought but clear information about their conditions, the medication and what it does to the body.

This guided the research team to develop information, education and communication materials in commonly used local languages. Patient engagement strategies, such as peer counselling, educational talks, and simplified health materials, contributed to a retention rate of over 89% in integrated care – a significant improvement compared to previous approaches.

Importantly, integrating services reduced duplication, lowered stigma around HIV, and optimised the use of limited resources. Continuous community dialogue, capacity development for health care workers, and infrastructural support proved crucial to improving the sustainability of the intervention delivery. The governments in both countries have embraced integrated chronic care and in Uganda, a letter from the Ministry of Health has been sent out instructing all facilities to implement this model. The findings were also used to inform the development of national HIV and ART guidelines (2022).

How we can we best engage communities in implementation research?

During the panel discussion, experts including Stephen Watiti, Deepika Saluja, and Shabbar Jaffar shared valuable insights and recommendations for advancing community engagement in implementation research:

• Researchers must take responsibility for ensuring that projects are community-led and driven, prioritising the involvement of lived experience perspectives, including in advocacy efforts that result from outputs. Creating safe spaces and processes that enable communities to actively lead implementation, and evaluation is essential. This requires patience, time and resources, to build trust. While fostering community leadership can take time, strong and well-organised community groups can also help accelerate the process. To support and sustain these efforts over time, funding applications must require including dedicated budget lines for long-term community engagement.
• Addressing the gap in understanding how to effectively engage communities is an important step to make meaningful progress. Researchers should engage in training and review the growing body of literature on community engagement and involvement (CEI) to develop context-specific, tailored approaches for direct engagement with communities. Documenting and sharing successful examples of CEI in practice can help guide meaningful implementation.
• Setting clear and measurable targets could help to drive impactful change. For example, establishing a target to ensure that 90% of individuals know their NCD status, have access to treatment, and understand disease management, like targets used in HIV programmes.
• Changing long-standing mindsets and addressing power imbalances remains a significant challenge and must be a priority if we are to transform both attitudes and practices including within researchers and programme implementers. Overcoming these cultural and behavioural barriers requires not only active community engagement but also critical self-reflection on our own power and positionality as researchers and programme implementers. By engaging in reflexivity and intentional actions to dismantle power asymmetries at our level, alongside evidence-based advocacy and behaviour change approaches, we can drive more meaningful and sustainable transformation.

By fostering trust, prioritising accessibility, and ensuring cultural sensitivity, implementation science can transform healthcare systems and the delivery of care. When patients, researchers, and policymakers work together, we can move beyond knowing what works to making it work in specific contexts – ensuring evidence-based interventions reach those who need them most, when and where they need them.

To learn more about the science of implementing NCD programmes across the world, try exploring the GACD e-Hub. The ‘Getting started’ page covers the major concepts in implementation research and the comprehensive ‘Fundamentals Programme’ will guide you through specially curated learning materials to kick off your journey

GACD’s top tips for engaging with policymakers is a resource for researchers seeking to effectively engage with policymakers and influence the policy-making process. These strategies are supported by practical examples from GACD projects.

This blog was authored by Claudia Selin Batz, Policy and Advocacy Advisor, UK and Multilaterals, at The George Institute for Global Health and Margaret Bee, Senior Impact and Policy Manager at The Global Alliance for Chronic Diseases (GACD) with valuable input from Josephine Birungi, Senior Research Scientist at the Medical Research Council Uganda unit, Bindu Patel and Kenneth Yakubu, Senior Research Fellows at The George Institute for Global Health.