Context
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Health facility: routine care; interaction with research project
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routine care was strengthened; strong interaction with research project strengthened through pre-existing collaboration with the research site
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routine care as usual; little interaction with research project but more interest from staff in the control site
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routine care as usual; interaction with research team interrupted due to change of site
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Environment: presence of health comm'y organisations; comm'y ties; physical environment
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no health comm'y organisations; strong comm'y ties; rural area - long travel distances
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presence of NGO with CHW; frequent migration hinders strong community ties; urban very disadvantaged neighbourhood, perceived safety concerns
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diabetes NGO not reaching the target population; community ties weak,social gatherings often religious/socially inspired; urban disadvantaged areas
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Organisational context: daily management
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Peer groups, supported by research field manager
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CHW non-governmental organisation
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SMART2D Research team
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a. Community mobilisation & Recruitment
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Implementation
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R
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Recruitment setttings
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Community house to house visits
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Facility chronic care clinics
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Community public spaces; facility registers
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Duration (months)
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11
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18
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18
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A
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Problems and adaptations
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large team of field assistants; need for strict quality control screening
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changed of site delayed familiarisation; university turmoil delayed team work; community sensitisation event
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chang of site; 2-step screening led to loss in recruitment, adaptation to 1-step & inclusion changed to high-risk
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Participation
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P
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Total number of people screened
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28976
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2150
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1965
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Number of people enrolled in community intervention
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268
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285
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131
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Problems experienced by potential participants
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enrolment at facility implied travel and waiting
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high mobility linked to circular migration decreased long-term participation
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language barriers
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b
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Peer support program
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Implementation
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C
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No of peer leaders/facilitators trained
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19
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10
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6
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No of initial + refresher trainings
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4 + 2
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3 + 2
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9
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Other supervision / monitoring support activities
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2 supervision visits / group
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weekly common mock sessions & quality assurance visit
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4 facilitator-mentor meetings
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R
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No of invitations to participants for peer support sessions
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1900
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375
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1281
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No of peer groups established & group size (median, range)
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19 groups: size 10 (4–27)
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3 groups: size 15 (10–20)
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72 peer - coach dyads
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D
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No of meetings / group: median (range)
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10 (NA)
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2 (1–2)
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3,5 (1–9)
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F
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No of groups covering all manual topics
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17
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none
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49
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Topics not / hardly covered
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alcohol & drug risks; community walk
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community walk; goal-setting
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care companion activities
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Quality of facilitation
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Overall score 7 out of 10
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median score 4 out of 5 (IQR 4–5) on leadership/content
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median score 81 out of 100 (IQR 76–94) on delivery: 75 (70–78) on interest
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A
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Problems
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manual too difficult; language not adapted
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management problems at implementing organisation: slow skill-building, manual not followed, poor record keeping, locations small
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participants hard to reach, several phone calls needed
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Adaptations
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retranslated, mock sessions
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more time, mock sessions; experienced peer facilitators to support
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individual coaching sessions
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testing opportunity increased attendance
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facilitator switches for language
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Mechanisms of Impact / participation
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P
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No of people that attended at least 1 session
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100%
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61/285 ~ 21%
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72/131 ~ 55%
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No of people that attended 1/3 of total sessions
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76/268 ~ 28%
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53/285 ~ 19%
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49/131 ~ 37%
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M
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Interaction with facilitator
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good: average score 7 out of 10
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median score 4 out of 5 (IQR 4–5) on participation
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good: median 75 out of 100 (IQR 69–81) on engagement
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B/F
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Problems experienced by participants
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timing sessions interferes with work, especially in agricultural season
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timing, safety, wheater, migration/informal settling, change of cell phone, other duties
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no time; language; variability in pre-knowledge
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c
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Care Companion (CC)
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Implementation
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C
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CC guide
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brochure
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information to CHW, not to patients
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oral information and brochure
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R
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No of people being offered the option of CC
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268/268 ~ 100%
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208/285 ~ 73%
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72/131 ~ 55%
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F
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Explanation of 6 CC tasks to CC
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by nurse at health center
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partly
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by facilitator and at sessions
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Systematic invitation to clinic visits and peer support
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Yes
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Yes
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Yes
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A
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Problems and adaptations
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failure to identify CC
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patients did not identify a peer; CHW became CC; little knowledge transfer
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patients did not want/peers did not want
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encouragement
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re-train & prep sessions on expectations
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pairing participants; multiple peers
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Mechanisms of change / Participation
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P
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No of people having a CC
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268/268 ~ 100% (on paper)
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CC performing at least 1/3 of agreed (home) visits: 185/285 ~ 65%
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43/131 ~ 33%
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M
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Reminding/Participation in clinic visits and/or peer support programme
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CC attendance of community activities (42/268 ~ 16%)
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Yes
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some joint actitivies
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Reminders to participants on medication and monitoring
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Active CC (roughly 50%) provided medication reminders
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Yes
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Not done
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Supporting physical activity and healthy diet
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Active CC (roughly 50%) reminders, sometimes support in cooking
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Focus on setting goals
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Limited attempts for joint activities
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B/F
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Problems by peers
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Many elderly, living alone
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People could not/did not want
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d
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Community-facility link
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Implementation
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C
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Explanation expectations
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Yes
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No
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training meetings in behaviour coaching
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D
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No community actors in contact with facility actors
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17: materials and feedback reciprocal
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Informal: not linked to community intervention
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2 meetings for all actors: facilitators, health workers, patients and experts
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F
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Intro between actors
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Yes
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Not in a structured way
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Yes
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Mechanisms of Impact / Participation
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B/F
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Barriers/facilitators
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CHW contact with health workers not structural, relationship perceived as unequal by CHW
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low interest in the other side of the link, little time investment done
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