Transforming Noncommunicable Disease Services in Low- and Middle-Income countries: a Scoping Review

Background : Understanding thepreferences, values, and needs of patients regarding what, where, when, and by whom comprehensive healthcare services provided is essential to improve utilization. This is especially critical among people requiring long-term care. There is a need to synthesise the available evidence on clients’ preference for noncommunicable diseases (NCDs) management. We conducted this scoping review to identify clients’ preferences for NCD-related services at the primary healthcare (PHC) level in low- and middle-income countries (LMICs). Methods: A scoping review was conducted based on the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping review. The included data sources were articles conducted by using discrete choice experiment among clients with NCDs at PHC levels. The analysis was guided by the Differentiated Service Delivery Framework, with the main findings analyzed using what, who, where, when, and how of service provision. Results : Twenty-seven articles from nine LMICs were included. The most frequent attributes were cost, accessibility to PHC settings (distance or travel time), continuity of care (e.g., friendly provider), waiting time to receive care, availability of equipment or medication, frequency of institution visit, health worker (e.g., level of expertise and gender), and treatment type (modern versus traditional care, particularly in China). Telemedicine use and date of services were rarely used. Clients preferred a model of care with lower cost, nearby facilities, friendly providers, shorter waiting times, less frequent follow-ups, individual provider visits instead of group therapy, and care provided by better educated and culturally tailored health workers, with settings and dates or times varying due to service variations. Conclusions : This scoping review highlights the importance of understanding clients’ preferences for NCD services at PHC levels in LMICs. Preferred attributes could be integrated into chronic care models to satisfy clients’ needs in response to dynamic population characteristics, emerging pandemics, and growing technologies. The date and telecommunication use could be better adapted besides the mostly agreed and practiced care model elements, such as lower costs, nearby facilities, friendly providers, shorter waiting times, and individualized visits. Service settings and timing were shown to vary based on the type of service and disease, with clients prioritizing specific attributes within each care continuum. Clinical Trail Number : Not applicable