A realist review to understand the complexity of effective management of type 2 diabetes and hypertension

Objectives: We aimed to disentangle the mechanisms that govern the effective management of diabetes and/or hypertension in various contexts in low- and middle-income countries. Methods: We conducted a realist review guided by the Realist and MEta-narrative Evidence Syntheses Evolving Standards. We systematically searched electronic databases to examine in what contexts, how, and for whom programs targeting diabetes and/or hypertension care work through context-mechanism-outcome (CMO) configurations and then revised an initial program theory to a refined program theory. Results: We identified four CMO configurations. (1) Cross-sectoral partnerships activate the mechanisms of resource pooling and mobilization, improving healthcare services coverage and fostering sustainable local buy-in (2) Integration of disease-specific programs facilitates coordinated care, resulting in treatment adherence (3) Digitalized infrastructure and literacy enable the mechanisms of mHealth and eHealth implementation and clinical decentralization, improving access, coordination, and treatment adherence (4) Patient-centered care triggers the mechanisms of patient-provider communication and personalized care, leading to patient engagement and health education. Conclusion: This review provides insights into the relevance of contexts and their associated mechanisms for operationalizing successful models of care for diabetes and/or hypertension that enhance health outcomes.