A team of researchers conducted a study to identify the effective core health-components, and contextual factors and programme elements of community-based interventions, regarding prevention and care for diabetes and hypertension. The study identified twelve core health-components that strengthen community-based interventions, and ten contextual factors and/or elements.
We found that comprehensive community-based interventions have a larger impact on diabetes and hypertension than interventions with only one component or aim. This implies that future community-based interventions could best include multiple components that address various contextual factors and implementation elements, including the social and healthcare context. Convergence of components could be achieved via one of the core health-components such as family and peer support. Another way is involving various stakeholders, for example, involvement of healthcare professionals in community programmes to increase synergy with primary health care. This is expected to have a higher impact on prevention and care of diabetes and hypertension.
One of the innovative findings is that telehealth was found to be a core health-component of community-based interventions, especially in rural areas. However, we also found that telehealth is more difficult to establish in more remote, rural areas because access to technology and internet connection is often limited, or absent, or only available under certain conditions. Multiple studies have shown that telehealth is effective in improving patient care and health outcomes, yet these findings were mostly based on urban areas. In rural areas with limited access to health care facilities, telehealth can substitute certain healthcare needs of community members if the technical infrastructure allows so. This should be further elaborated on for prevention and care for NCDs, as technology and connections are evolving rapidly, even in rural areas.
Another innovative finding identified regarding core health-components is storytelling. Research in health literacy programmes showed that people with low literacy skills finds it difficult to read and understand written health information; thus non-written strategies (such as graphics and photos) of storytelling can be an effective way of increasing health literacy. Moreover, this component can be easily adapted to the context, making it culturally sensitive, so probably more effective given the results of our review. In addition, Involving peers that people with NCDs can relate to, especially when health literacy is low, can be a context-adapted component of interventions.
Regarding contextual factors, we found multiple documents that reported implementation problems as potential barriers, such as insufficient equipment and human resources. Implementation problems can also be the result of diminished implementation fidelity, i.e. the extent to which an intervention is delivered as intended. Implementation fidelity in community-based interventions is often low, because these programmes are not adapted to real life contexts and culture. This corresponds with our finding that community-based interventions have a higher impact when tailored to the culture. To increase implementation fidelity, interventions should be tailored to culture, by including local adaptions.
This review contributes to an in-depth understanding of what core health-components work in community-based interventions, including which factors and elements work in particular South East Asian contexts. The findings from this study can serve as a foundation for future research and intervention activities in the SUNI-SEA project.
 Zinzi E. Pardoel, Sijmen A. Reijneveld, Robert Lensink, Vitri Widyaningsih, Ari Probandari, Claire Stein, Giang Nguyen Hoang, Jaap A.R. Koot, Christine J. Fenenga, Maarten Postma, Jeanet J.A. Landsman