Integrating places of worship (PoWs) into the primary care pathway to prevent and control non-communicable diseases (NCDs) in the Caribbean (360G-Wellcome-205329_Z_16_Z)

We will evaluate the integration of health advocates in places of worship into the primary care pathway and the potential impact on health literacy, adoption of healthy lifestyles, early detection and referral, and NCD management. The Caribbean has the highest NCD mortality in the Americas placing huge pressure on fragile health systems. Task shifting and collaborative community-based interventions are advocated to reduce inequalities in health and address the burden of NCD, but have seldom been evaluated in LMIC. The intervention will be conducted in 3 of the least affluent CARICOM countries with differing sociocultural contexts to enhance adaptability. We will recruit health advocates from places of worship in poor urban and rural communities to conduct health promotion activities, support treatment adherence, and ensure prompt referral. Our intervention has the features of a complex intervention, i.e. multiple components and outcomes, interactions and feedback loops between intervention and context. Based on the principles of realist evaluation and MRC guidelines for the evaluation of complex interventions, we will evaluate the intervention in real time to observe the interaction between the context of the intervention, the mechanism (how it works), and the outcomes. We will use a mixed methods approach including: 1) concept mapping with stakeholders to gather information on factors influencing implementation, prioritise areas for health system improvement, and foster collaboration; 2) observation and interviews with congregants and health advocates to track the implementation in context over time; 3) quantitative survey of congregants at baseline and endline to examine the influence of the intervention on lifestyle change, health literacy, satisfaction with services, and well-being. If the intervention is successful we will develop a toolkit for up-scaling across the Caribbean through established partnerships with health ministries and regional stakeholders.