Community-based interventions for non-communicable diseases in Africa: A scoping review of scope, effectiveness, and implementation factors

Community-based interventions for non-communicable diseases in Africa: A scoping review of scope, effectiveness, and implementation factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Community-based interventions for non-communicable diseases in Africa: A scoping review of scope, effectiveness, and implementation factors Pascal Mathew Okorobe, John Onama, Omosola Lydia Bolarin, Saheed Adekunle Akinola, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8508373/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background The increase of non-communicable diseases (NCDs) across Africa has become a major public health concern, contributing to significant morbidity and mortality which exerts significant strain on the already burdened health systems. Community-based interventions (CBIs) offer a strategy to address these diseases but evidence remains scattered on their effectiveness, contextual factors that enable or hinder their implementation. This review aims to map existing community-based interventions, assess their outcomes, identify key facilitators and barriers, and highlight gaps in the literature across diseases, populations, and regions. Methods This review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched PubMed, Scopus and Web of Science to identify studies. Results were synthesized thematically and reported using a narrative approach. Results This review analyzed 91 studies from across Africa, with most conducted in South Africa, Kenya, Uganda, and Nigeria, focusing on community-based interventions for NCDs. The interventions addressed screening, health promotion, integrated care, and Health, targeting mainly hypertension, diabetes, cancers, and mental and neurological disorders. Overall, CBIs enhanced screening, health literacy, and selected clinical outcomes, especially blood pressure control, although continuity and linkage to formal care were inconsistent. Key facilitators included trusted community health workers and culturally tailored approaches, task-shifting, proximity to people, and use of digital technologies while limited resources, poverty, stigma, and fragile health systems posed major challenges. Conclusion Community-based interventions for NCDs in Africa demonstrate huge potential to counter the rising NCD burden but encounter significant challenges; successful implementation requires resource sensitive and cultural tailored strategies. Non-communicable diseases community-based interventions community engagement effectiveness facilitators barriers Figures Figure 1 Figure 2 1. Background Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, cancer, and chronic respiratory illnesses are rapidly rising in prevalence across Africa, contributing significantly to morbidity and mortality in both urban and rural settings.[ 1 – 3 ]. Globally, Cardiovascular diseases account for most NCD deaths, that is − 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). NCDs kill 41 million people each year globally, and 77% of all NCD deaths are in low- and middle-income countries. [ 4 ] The continent has traditionally grappled with infectious diseases, maternal and child health, nutritional related diseases,[ 5 ] but over the years, the morbidity and mortality from NCDs has increased, which the World Health organization (WHO) states a rise from 24% in 2000 to 37% in 2019 deaths caused by NCDS in Africa.[ 4 ] These places significant pressure on already strained healthcare systems, increasing demand for both acute and chronic care services, especially in urban and poor populations.[ 6 ] Community-based interventions (CBIs) are strategies implemented within specific geographic communities such as neighborhoods, schools, churches, or workplaces with the aim of improving health outcomes. These interventions often use educational, organizational, and policy-level approaches that engage individuals, families, social networks, and institutions. While they may involve community input through advisory groups or coalitions, their primary focus is on influencing individual behavior change, with population-level impact seen as the collective result of these individual changes.[ 7 ] They are defined by their emphasis on community participation, the involvement of local health workers, and the adaptation of programs to fit cultural and social contexts.[ 8 ] Community based health interventions have shown many positive health outcomes including early detection of NCDs, increased adherence to treatment and modification of lifestyles for prevention.[ 8 – 10 ] There is growing interest in community-based health interventions for the prevention and control of NCDs in Africa, reflecting the urgent need to address the rising burden of these conditions across the continent.[ 11 – 14 ] While some studies highlight the potential of CBIs such as those involving community health workers, integrated care models, and participatory approaches to improve access to care and support disease management, there is limited understanding of the specific contextual enablers and barriers that influence their success. For example, challenges such as insufficient training, weak inter-sectoral collaboration, inadequate resources, and unclear roles for community health workers have been identified as obstacles to effective implementation. [ 15 , 16 ] Additionally, the adaptation of interventions to local cultural, social, and economic contexts is often insufficiently addressed, which can limit both uptake and impact. [ 17 ] Given the heterogeneity of CBIs and the unique socio-cultural and economic contexts in Africa, a scoping review is appropriate to explore the progress made and gaps in implementing CBIs for NCDs. With this scoping review, we aim to: (1) identify the types of community-based interventions that have been implemented to prevent or manage NCDs among populations in African countries; (2) assess the reported outcomes and effectiveness of these interventions; (3) explore the key facilitators and barriers influencing their implementation; and (4) highlight gaps in the existing literature, particularly in relation to understudied populations, specific NCDs, and geographic regions. 2. Methods This scoping review followed the methodological framework proposed by Arksey and O’Malley, 2005, enhanced by Levac et al., 2010[ 18 ] and the Joanna Briggs Institute[ 19 ]. It consisted of the following stages (1) identifying the research question(s), (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting results. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.[ 20 ] This review protocol was registered on Open Science Framework and available at https://osf.io/4qe76/ Step 1: Identifying the review questions and eligibility criteria This was guided by questions developed using the PCC framework (Population, Concept, Context). The main question was: What is the scope of community-based interventions for the prevention and management of NCDs in Africa, including their progress, effectiveness, and gaps ? The secondary study questions developed using this framework were: What types of community-based interventions have been implemented to prevent or manage NCDs among populations in African countries ? Population: Individuals or communities in Africa affected by or at risk of NCDs. Concept: Community-based interventions (e.g., health promotion, screening, self-management). Context: African countries. 2. What are the reported outcomes and effectiveness of community-based interventions for NCDs in African communities 2. What are the reported outcomes and effectiveness of community-based interventions for NCDs in African communities ? Population: Individuals or communities in Africa with or at risk of NCDs Concept: Outcomes and effectiveness of CBIs (e.g., behavior change, disease control). Context: African countries. 3. What facilitators and barriers influence the implementation of community-based interventions for NCDs in African settings? Population: Communities and health workers implementing CBIs in Africa. Concept: Facilitators and barriers to CBI implementation Context: African countries. 4. What gaps exist in the literature on community-based interventions for NCDs in Africa 4. What gaps exist in the literature on community-based interventions for NCDs in Africa ? Population: Individuals or communities in Africa with or at risk of NCDs Concept: Gaps in CBI research (e.g., lack of data on specific NCDs or intervention types). Context: African countries. Eligibility criteria. Eligibility criteria defined using the PCC framework: Population Individuals or communities in African countries affected by or at risk of NCDs (e.g., cardiovascular diseases, diabetes, cancer, chronic respiratory diseases). Studies focusing on children, adolescents, adults, or older adults will be included. No restrictions on age, gender, or socio-economic status. Concept Community-based interventions for NCD prevention or management. CBIs are defined as health promotion, prevention, or management programs delivered in community settings (e.g., villages, neighborhoods, schools, faith-based organizations) involving community members, community health workers, or local organizations. Interventions may include health education, screening, lifestyle modification, or self-management programs. Context Studies conducted in any African country (as defined by the African Union’s 54 member states). Studies from urban, rural, or peri-urban settings in Africa will be included. Global or multi-country studies will be included only if they provide specific data for African countries. Inclusion Criteria : Peer-reviewed articles published in English. Primary Studies published from 2000 to 2nd July 2025 (last date of search) Qualitative, quantitative, or mixed-methods studies reporting on CBIs for NCDs in Africa. Studies addressing intervention design, implementation, outcomes, facilitators, barriers, or gaps. Exclusion Criteria : Studies focusing solely on communicable diseases or non-community-based interventions (e.g., hospital-based care). Studies conducted outside Africa or lacking Africa-specific data. Secondary studies, editorials, protocols, commentaries, or opinion pieces without empirical data Step 2: Identification of studies A comprehensive search strategy developed following the JBI three step framework.[ 21 ] First, a preliminary search was initiated using selected keywords. The titles and abstracts of the retrieved articles were analyzed to uncover relevant synonyms, related terms, and indexing language. To ensure comprehensive coverage, Medical Subject Headings (MeSH) and other controlled vocabularies were explored. The developed search strategy was subsequently be refined and validated. Secondly, a full search was conducted across three databases (Pubmed, Scopus and Web of Science) and lastly, the results were screened for duplicates. The search strategy for each database is provided in supplementary file 1. Step 3: Selection of studies Articles were selected against inclusion and exclusion criteria using rayyan software.[ 22 ] Two reviewers PMO and JO independently screen all titles and abstracts to evaluate their relevance according to the predefined inclusion criteria. Studies potentially eligible underwent full-text review by the same reviewers, who assessed them thoroughly against the same criteria. Any disagreements encountered during the screening or full-text review phases were addressed through discussion, and if consensus wasn’t reached, a third reviewer KYA resolved the conflict. The full search and selection process, including the number of records at each stage was summarized using a PRISMA flowchart. Step 4: Data extraction and charting Data from the included studies was systematically extracted using a standardized charting form developed and pilot-tested by the review team. This form captured key details such as authorship, year, country, study design, sample size, setting, and population characteristics. It also included information on the type and delivery of community-based interventions, duration, stakeholders involved, and reported effectiveness and outcomes, including health and behavioral changes. Additionally, data on implementation factors such as facilitators, barriers. All included articles were subjected to double data extraction by two reviewers independently, and a 3rd reviewer compared both extractions for any discrepancies and completeness which were resolved. Step 5: Data synthesis, collating and reporting the results Descriptive statistics of frequency and percentage were used to summarize the study characteristics. A map showing the distribution of included studies was created using RStudio Version 2025.05.1 + 513. A narrative synthesis was used to summarize the results of the included studies into themes in alignment with the review questions, allowing for a structured description of the types, scope, and implementation of community-based interventions for NCDs in Africa. 3. Results 3.1 Study Characteristics 3.1.1 Study Selection. A total of 5381 studies were retrieved of which 91 were included in thematic synthesis as shown in Fig. 1 . 3.1.2 Distribution of studies Fifteen countries were represented with South Africa (n = 20), Kenya (n = 19), Uganda (n = 16), Nigeria (n = 11) and Ethiopia (n = 7) accounting for most of the studies. 1 study was multi-country (Uganda and Kenya). Figure 2 shows the distribution of these studies by country. 3.1.3 Study Designs and Methodologies The largest proportion of studies utilized qualitative designs (n = 24), including phenomenological approaches, focus group discussions, and in-depth interviews, primarily to explore the feasibility, acceptability, and implementation context of these programs. Mixed-methods studies (n = 16) were also prominent, often combining screening data with qualitative inquiry to provide a holistic view of intervention impact. Evaluative research was well-represented by quasi-experimental designs (n = 17), such as pre-post intervention studies, and experimental designs, including Cluster Randomized Controlled Trials (cRCTs) and pilot RCTs (n = 9). The remaining consisted of observational studies (n = 8) such as cross-sectional surveys, prospective cohorts, and diagnostic accuracy studies alongside a smaller subset of general pilot/feasibility studies (n = 5) and cost-effectiveness analyses (n = 2). The majority of studies evaluated active interventions, a subset (n = 6) utilized observational or formative designs to assess existing community structures or feasibility without deploying a new program 3.1.4 Target NCDS The community-based interventions included in this review addressed a wide, though uneven, spectrum of NCDs. Cardiovascular Diseases (CVDs) were the most studied group, with Hypertension targeted 36 times (including combinations with other conditions), Stroke 2 times, and general CVD risk factors 5 times. Cancers were addressed in a total of 19 studies. This focus was highly specific, dominated by Cervical Cancer in 16 instances (including 3 combined with breast cancer), with only Breast Cancer alone targeted 1 time, and Prostate Cancer 1 time. Diabetes was addressed in 17 studies, with Diabetes and Hypertension combined 10 times, and Diabetes Mellitus (Type 1 and/or Type 2) exclusively 6 times. Mental and Neurological Disorders were targeted 15 times, covering Dementia (4 instances), Psychotic Disorders (2 instances), Postpartum/Perinatal Mental Disorders (2 instances), and Autism/Developmental Disorders (2 instances). Other conditions receiving minimal attention included Chronic Respiratory Diseases (Asthma and COPD, 2 instances), Pregnancy-related Hypertensive Disorders (2 instances), and Sickle Cell Disease (SCD) (1 instance). Seven studies also focused on broad NCD Risk Factors/General NCDs. 3.2 Types of Community-Based Interventions We identified a wide array of community-based interventions (CBIs) ranging from targeted screening campaigns to comprehensive, multi-component disease management programs. These are depicted in Table 1 . 3.2.1 Screening and Early Detection Strategies Screening was the most predominant intervention type, implemented through two primary delivery models: door-to-door household visits and mass community campaigns. Door-to-Door Screening Community Health Workers (CHWs) and Health Extension Workers (HEWs) were deployed to households to measure vital signs and carry out simple tests. This approach was widely used for hypertension and diabetes, utilizing portable electronic blood pressure monitors and glucometers[ 23 – 30 ]. Specialized home-based screening was also employed for dementia and cognitive impairment [ 31 , 32 ] as well as for COPD using lung function questionnaires and peak flow meters[ 33 ]. Campaigns and Health Fairs Other interventions utilized high-throughput screening at central locations such as markets, schools, and places of worship. These included multi-disease “Community Health Campaigns”[ 34 ], church-based screenings for psychological distress[ 35 ], and comparative studies evaluating home-based and community strategies[ 36 ]. Cancer Screening Innovations Interventions for cervical cancer heavily utilized task-shifting. Strategies included training CHWs to conduct Visual Inspection with Acetic Acid (VIA ) [ 37 – 39 ] and the distribution of self-sampling kits for HPV to increase privacy and uptake[ 40 – 44 ]. 3.2.2 Health Education and Health Promotion Educational interventions aimed to improve health literacy and modify risk behaviors using culturally adapted delivery methods. Group and Peer-Based Learning Structured group sessions were common, such as the "Lifestyle Africa" diabetes prevention program[ 45 ], community health clubs[ 46 , 47 ] and supervised community exercise sessions[ 48 ]. Innovative Communication Novel approaches included the use of applied drama and theatre to share patient stories[ 49 ] and the use of a "story-telling cloth" (textile) to facilitate community dialogue on health topics[ 50 ]. Targeted Counseling Specific programs targeted deeply ingrained beliefs, such as education to counter fatalistic views on prostate cancer[ 51 ] or integrated health messaging into traditional marriage counseling[ 52 ]. General Awareness Broader awareness campaigns utilized radio, social media, and beating" traditional community announcements alongside CHW outreach[ 53 – 57 ]. 3.2.3 Integrated Management and Linkage to Care Beyond screening, several interventions established comprehensive care models to bridge the gap between community detection and clinical treatment. Task-Sharing and Home-Based Care These programs shifted clinical tasks to lay workers. Examples include CHWs delivering medications directly to patients’ homes[ 58 – 60 ] conducting post-discharge rehabilitation for stroke survivors[ 61 ], and managing mental health cases after training in identification and referral[ 62 – 64 ]. Linkage Strategies To ensure screen-positive individuals reached facilities, interventions employed referral vouchers, SMS reminders for appointments, and "screen-and-treat" models where VIA positive women received same-day thermocoagulation treatment in the village[ 25 , 34 , 38 , 44 ]. Self-Management Support Interventions empowered patients to manage their conditions through home blood pressure monitoring combined with CHW coaching on diet and adherence[ 65 – 68 ]. 3.2.4 mHealth and Technology Enablers Technology was employed in multiple intervention types. Mobile health (mHealth) tools were used for data collection and decision support, such as the AfyaChat app for CVD risk assessment[ 69 ], tablet-based dementia screening[ 31 ], and smartphone-guided referrals[ 29 , 69 – 71 ]. Additionally, telehealth models enabled CHWs to connect patients in remote villages with clinicians via video for real-time consultations[ 58 ]. Table 1 Characteristics of Community-Based Interventions Intervention Category Primary Implementors Delivery Methods & Study Examples Screening & Early Detection CHWs, HEWs, Nurses Door-to-door : BP/Glucose checks[ 23 , 25 , 26 , 28 ] Cognitive screening[ 31 , 32 ] COPD checks[ 36 ], Prenatal depression screening[ 72 ]. Campaigns : Church screenings[ 35 ], Cervical cancer outreach[ 37 , 73 ]. Self-Testing : HPV self-sampling[ 41 – 44 ]. Health Education & Promotion CHWs, Volunteers, Peers Group : Lifestyle workshops[ 45 ], Exercise classes[ 48 ], Health clubs[ 47 , 74 ]. One-on-One : Household counseling[ 35 , 66 , 75 ] Creative : Drama/Theatre[ 49 ], Story-telling cloth[ 50 ], Marriage counseling[ 52 ]. Integrated Management CHWs, HSAs, Pharmacists Medication Delivery : Home delivery of meds by CHWs[ 59 , 60 ] . Linkage : Referral vouchers[ 34 ], SMS reminders[ 53 ]. Clinical Care : "Screen-and-Treat" (VIA + Thermocoagulation)[ 38 ], Home-based stroke rehab[ 61 ], Mental health integration[ 62 , 64 ]. mHealth & Digital CHWs, Research Staff Tools : Smartphone risk assessment[ 69 , 71 ], Telehealth consultations[ 58 ], Tablet-based data collection[ 73 ]. 3.3 Outcomes and Effectiveness of Community-Based Interventions The review identified 86 studies reporting intervention outcomes, providing mixed but largely positive evidence regarding the utility of community-based interventions (CBIs). While these programs consistently demonstrated high effectiveness in expanding screening reach and improving health literacy, the impact on long-term clinical outcomes and linkage to formal care was variable, often influenced by the intensity of the intervention and health system capacity. 3.3.1 Clinical Health Outcomes Evidence regarding the impact of CBIs on physiological health outcomes was predominantly positive for hypertension control. Multiple interventions reported statistically significant reductions in systolic and diastolic blood pressure, with decreases ranging from 2.75 mmHg to over 24 mmHg compared to control groups[ 27 , 36 , 46 , 55 , 58 , 66 , 67 , 76 , 77 ]. Correspondingly, several studies demonstrated that community-based care significantly increased hypertension control rates[ 58 , 59 , 66 , 78 , 79 ], and one cost-effectiveness analysis found that "step-down" medication dosing by CHWs maintained blood pressure control while reducing costs[ 80 ]. However, the evidence was not unequivocal; a subset of studies found no statistically significant difference in blood pressure reduction between intervention and control arms[ 54 , 55 , 81 ], or found effects only in specific sub-groups such as younger adults[ 54 ]. Results for other conditions were similarly mixed. For diabetes, home delivery of medication was associated with improved glycemic control[ 60 ], yet one study found that patients receiving standard clinic care achieved better outcomes than those in the community arm[ 59 ]. In the context of stroke rehabilitation, home-based care significantly improved functional independence scores[ 82 ], although mortality and residual disability remained high [ 61 ]. Furthermore, One community engagement study for preeclampsia found no significant reduction in composite maternal/newborn mortality despite increased contacts[ 70 ]. A community based rehabilitation for Schizophrenia was acceptable, and improved functioning of patients[ 83 ] 3.3.2 Screening Reach and Diagnostic Accuracy A primary strength of CBIs was their ability to expand access to diagnosis. Interventions successfully reached large populations, identifying high rates of undiagnosed conditions such as hypertension, diabetes, and cervical cancer[ 25 , 26 , 28 , 31 , 37 , 69 , 71 , 77 ]. Community mobilization strategies, including mass campaigns and innovative "story-telling" approaches, led to substantial increases in screening uptake, with some studies reporting up to a five-fold increase[ 50 , 84 ]. Self-sampling models for HPV were particularly effective, achieving high participation rates due to increased privacy[ 38 , 41 , 43 , 85 ], though participation in some campaigns declined over time due to community rumors[ 86 ]. When standardized tools were utilized, task-shifting to lay workers generally yielded acceptable diagnostic accuracy. Health Extension Workers (HEWs) and CHWs achieved high sensitivity and specificity for hypertension[ 23 , 27 ] and mental health screening[ 29 , 30 ]. However, accuracy was not uniform; some studies reported low specificity leading to over-referral [ 32 ], or poor diagnostic capability when CHWs worked without supervision[ 72 , 87 ] Linkage to Care and Retention Some interventions achieved high linkage rates (above 80%) within six months, particularly when referrals were made to nearby primary health facilities and when demographic and social predictors favored access[ 34 ] However, despite high screening yields, linkage to formal care remained a critical bottleneck in the care cascade. Numerous studies observed a "leakage" effect, where high screening numbers did not translate into sustained treatment; linkage rates frequently fell way below the screened numbers. [ 49 , 66 , 69 , 75 , 88 – 90 ], and loss to follow-up was also reported. [ 57 , 78 , 86 ]. Behavioral, Knowledge, and Stigma Outcomes Beyond clinical metrics, CBIs were highly effective in modifying health beliefs and increasing literacy. Educational interventions consistently led to statistically significant increases in knowledge regarding cervical cancer symptoms and risk factors[ 91 – 94 ], diabetes management[ 45 ], and general NCD awareness[ 95 , 96 ]. Furthermore, these programs successfully targeted deep-seated stigma. Interventions significantly reduced fatalistic beliefs regarding prostate cancer[ 51 ] and decreased social distance towards marginalized groups, including children with autism[ 88 ] and people with dementia[ 75 ] or psychosis[ 97 ]. While knowledge improved, behavioral changes were more complex; some studies reported reductions in physical inactivity[ 55 ], while others found no significant improvements in body mass index or obesity despite lifestyle counseling[ 47 , 48 , 66 ] Feasibility and Cost-Effectiveness Finally, qualitative and process data highlighted the viability of these models. Most interventions were deemed feasible and acceptable by communities, including those utilizing mHealth tools[ 69 , 71 , 75 , 98 ] or home-based care models[ 53 , 62 , 82 , 99 – 102 ]. Where assessed, economic analyses consistently found CBIs to be cost-effective or cost-saving, with favorable incremental cost-effectiveness ratios[ 45 , 65 ], suggesting they represent a "good buy" for health systems in low-resource settings. 3.4 Facilitators and Barriers to Implementation 3.3.1 Health System and Workforce Factors Facilitators : The most consistent enabler across studies was the trust and familiarity of the workforce. Community Health Workers (CHWs) were frequently described as trusted "village doctors," neighbors, or "sons of the soil," which facilitated entry into households and improved acceptability [ 38 , 44 , 68 , 99 , 100 , 103 ]. Task-shifting was feasible when supported by structured training; effective strategies included the use of simple, standardized tools (e.g., "pocket guides," aneroid BP machines) and video-based training modules[ 26 , 32 , 45 , 51 , 65 ]. Integration with existing services was another key success factor; embedding NCD care into HIV platforms, mental health services, or church activities improved feasibility and reduced duplication [ 33 , 41 , 62 , 85 ]. Availability of inputs, support supervision and training of CHWs were also reported enablers.[ 89 ] Barriers : However, the workforce was often unsupported. A major barrier was resource scarcity, particularly the stockouts of equipments and supplies for use in the community and at referral clinics.[ 27 , 28 , 59 , 68 , 74 , 80 , 100 ]. Equipment failure was rampant, with reports of broken blood pressure machines and dead batteries halting screening efforts[ 24 , 26 , 78 , 99 , 104 ]. Systemic issues included staff shortages and inadequate supervision; some studies noted that CHWs received little feedback from facility health professionals [ 47 , 59 , 65 , 79 , 105 ]. Furthermore, CHW workload and lack of financial incentives were critical challenges, with volunteers often overburdened by vast catchment areas and the "opportunity costs" of unpaid work[ 78 , 100 , 104 , 106 – 108 ], Lack of confidence in their personal abilities, lack of training and limited health system support were also reported by CHWs.[ 108 , 109 ]. CHWs knowledge gaps were also reported.[ 110 ] 3.3.2 Community and Socio-Cultural Factors Facilitators : Interventions succeeded when they were culturally adapted. The use of local languages[ 37 , 63 , 75 , 95 ] and the involvement of community leaders, traditional chiefs, and religious figures[ 24 , 35 , 63 , 70 , 81 , 89 , 101 ] were vital for gaining entry and endorsement. Peer support and group dynamics were also beneficial, fostering a sense of shared experience and reducing isolation[ 48 , 66 , 74 , 75 ]. Barriers : Deeply ingrained beliefs and stigma posed significant hurdles. Patients frequently attributed symptoms (such as those of dementia, stroke, or mental illness) to witchcraft or supernatural causes rather than medical conditions[ 63 , 75 , 102 , 111 ]. Stigma was a specific barrier for mental health and smoking-related conditions[ 31 , 36 , 42 , 85 , 109 ]. Gender dynamics played a restrictive role; studies reported that women often required spousal permission to access care. Husband disapproval or "male partner resistance" was a specific, recurring barrier to cervical cancer screening and HPV self-sampling[ 35 , 37 , 57 , 68 ]. Additionally, community rumors (e.g., fears of uterus removal or "spies") and lack of awareness occasionally hindered interventions [ 35 , 53 , 89 ]. Low community trust and lack of interest was also an issue[ 108 ]. 3.3.3 Logistical and Economic Factors Facilitators : Proximity was the strongest logistical enabler. Home-based (door-to-door) screening and "screen-and-treat" models removed the need for travel, significantly boosting uptake[ 28 , 36 , 59 , 76 , 79 , 82 , 84 ]. Technology (mHealth) served as a powerful tool for standardizing care and guiding referrals, provided devices were functional and charged[ 25 , 31 , 53 , 58 , 69 , 98 , 112 ]. Economic incentives, such as transport vouchers, were crucial for converting screening into linkage[ 34 ]. Barriers : Conversely, poverty was the overarching structural barrier. The cost of transport to referral facilities was frequently cited as the primary reason for loss to follow-up[ 29 , 31 , 33 , 34 , 36 , 56 , 75 , 76 ]. Even when screening was free, the cost of treatment or vaccines prevented effective care[ 35 , 39 , 113 ]. Migration and mobility (e.g., participants relocating for work) disrupted continuity of care[ 25 , 33 , 40 , 72 ]. Finally, the asymptomatic nature of NCDs led to complacency, with many patients "feeling well" and thus deprioritizing clinic visits[ 34 , 53 , 69 ]. 4. Discussion We conducted a scoping review to map the scope, effectiveness, facilitators and barriers to implementation of CBIs targeting NCDs in Africa. Our review revealed evidence of CBIs across 15 African countries, with South Africa, Kenya, Uganda, and Nigeria accounting for most of the studies. This implies that we found no evidence in about 39 of the 54 countries classified among African countries. This finding suggests geographically concentrated research on community-based NCD interventions in Africa, with South Africa, Kenya, Uganda, and Nigeria dominating the literature. Similar geographic concentration has been observed in previous reviews examining the sustainability of health interventions in sub-Saharan Africa, where Kenya and Nigeria had the most representation[ 114 – 116 ]. This observation is concerning since NCDs represent an expanding burden across all African countries and require evidence-based community interventions tailored to their diverse contexts. We also found variations in intervention effectiveness across different NCDs and implementation contexts. Hypertension interventions demonstrated the most consistent positive outcomes, with community-based approaches showing reduction in both systolic and diastolic blood pressure, though the evidence base remains inconsistent. Self-sampling models for cervical cancer screening worked well, but the results for mental health and diabetes management were less consistent, depending on how much help CHWs gave and how easy it was to obtain medications at referral facilities. This variation in effectiveness requires contextualized approaches that account for specific disease characteristics, healthcare system capacities, and community preparedness. Previous literature highlighted that priorities for disease management in primary care include the availability of essential diagnostic tools and medications at local primary healthcare clinics, along with standard protocols for diagnosis, treatment, monitoring, and referral to specialist care[ 117 ]. Our findings confirm that CBI interventions performed better when these foundational elements were in place. Key facilitators were rooted in the local context. The trusted status of CHWs was repeatedly cited: community members viewed Health Extension Workers or CHWs as “family” or “neighbours,” enhancing participation and adherence. Programs that leveraged the trust of community health workers viewed as neighbours or ‘one of us’ reported higher participation and adherence in screening activities and other health behaviors.[ 118 ] Studies show that CHWs improve health knowledge and community care-seeking, acting as a bridge to formal services. Formal training and supervision also mattered: interventions that gave CHWs clear protocols, simple tools (BP cuffs, flipcharts), and ongoing support reported better performance. Integration into existing structures (e.g. piggybacking on HIV or maternal health platforms, involving local leaders and clinics) further anchored programs in the health system and community networks. On the socio-cultural side, tailoring messages to local languages and engaging traditional authorities or peer groups proved critical to acceptance, as did framing health behaviors in culturally relevant ways. Formal training, ongoing supervision and logistical support (including simple tools) are linked to higher CHW performance and community acceptance.[ 119 ] Conversely, barriers frequently undermined impact. Health system constraints loomed large: many programs reported shortages of supplies (e.g. broken BP machines, depleted testing kits) and erratic drug availability, often halting services mid-stream. Workforce issues were also a problem – overworked, unpaid CHWs sometimes lost motivation. These issues echo known challenges in African health systems[ 119 ] and imply policy remedies: stable funding and supply chains for NCD programs are needed, and CHW programs must include incentives or career pathways to sustain motivation. Socio-economic hurdles were also critical. Poverty and transport costs consistently impeded care: even when screening was free, many diagnosed individuals could not afford repeated clinic visits or medications.[ 120 ] This suggests policy fixes such as travel vouchers or decentralizing treatment (e.g. home drug delivery) can meaningfully improve linkage to care. Cultural factors too created barriers: in some communities, illnesses (especially mental/cognitive ones) were attributed to witchcraft or spirits engendering stigma. Deep-rooted cultural beliefs and mistrust in health programs can limit engagement, particularly where traditional health systems and explanations of illness differ.[ 120 ] Gender norms were relevant in women’s health for instance, cervical cancer outreach faltered when husbands disapproved. Addressing these requires culturally sensitive strategies: involving community leaders, providing couple’s education or male outreach, and sustained community dialogue can help overcome fatalism and mistrust. Implication for Practice The review study included interventions from African countries where most clients with NCDs still present late or remain undiagnosed, thus increasing the morbidity and mortality associated with NCDs in Africa. Screening through door-to-door visits and community campaigns is one way to find undiagnosed NCDs early, but clinical exams and lab tests give more certain diagnoses[ 121 , 122 ] This approach assumes that people who are screened will be able to get to health facilities, but our research showed that many people who test positive never get treatment. Fundamental drivers of successful CHW programs include structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training[ 123 , 124 ] Our findings showed that some interventions were able to achieve blood pressure control, improve glycaemic management, and benefit from rehabilitation through consistent CHW support when these elements were present. It implies that comprehensive training on screening, referral, and follow-up will have a substantial impact, especially when CHWs are equipped with functional tools, provided regular supervision, and compensated fairly for their work. When communities are mobilized effectively, individuals receive regular screenings using validated tools, and referral systems provide transport support and same-day treatment options when feasible, early detection can lead to timely care, thereby reducing morbidity and mortality associated with NCDs. Our review showed most interventions were deemed feasible and acceptable by communities. Therefore, intensive public and institutional education, combined with strengthened referral systems, is required to maximize the impact of community-based NCD interventions, aiming for early detection, successful linkages to care, and sustained treatment adherence. Implications for Research Our study highlights geographic concentration in research on community-based interventions for NCDs in Africa, with limited studies from Francophone and Lusophone countries. Most interventions addressed hypertension and cervical cancer, but fewer covered diabetes, chronic respiratory diseases, and mental health. We hope this study spurs research on under-represented NCDs and countries, where NCDs are also rising. We recommend primary studies evaluating the long-term sustainability and cost-effectiveness of CBIs beyond pilot phases. Sustainability research stresses ongoing benefits after funding ends, continued programme activities post-withdrawal, and community empowerment to sustain efforts.[ 125 , 126 ] We also urge studies on the best training for community health workers, compensation, and supervision to ensure quality and retention. Strong leadership and alignment with government priorities improve success, so research on policy integration and health system readiness is needed. Further, a systematic review and meta-analysis could quantify the pooled effectiveness of intervention components across NCD categories in African settings. Studies on factors enabling linkage to care after community screening would address observed "leakage" in the care cascade. Most included studies were pilots with short follow-ups. There is the need for long-term evaluations and implementation research to scale sustainable CBIs across diverse African health systems. Finally, equity considerations were insufficiently explored, with few studies examining differential effects across gender, socioeconomic status, rurality, or marginalized populations. Contextual factors like health financing, political stability, and urban-rural differences, which influence success, were not systematically examined. Therefore, further studies should explore this. Strengths and Limitations This scoping review is likely the first to map community-based NCD interventions comprehensively across Africa. It reveals geographic concentration in South Africa, Kenya, Uganda, and Nigeria, alongside evidence gaps elsewhere. Our methods enabled systematic article identification, intervention charting, and outcome analysis across NCDs. However, our study is limited by its diverse study designs (observational and experimental), yielding variable evidence quality. No formal quality appraisal was done, consistent with scoping reviews, but its absence restricted the assessment of robustness. We searched 3 databases; studies in other databases may have been missed; future work should expand searches. The review we conducted covered only English publications and only non-English ones with available translations, potentially excluding French, Portuguese, or other-language studies, especially from Francophone and Lusophone Africa. Grey literature or alternative terms may also have been overlooked, despite broad search strategies. Detailed meta-analysis for precise effect sizes was beyond scope Conclusion Community-based interventions are an effective strategy for addressing the rising burden of NCDs in Africa. This review demonstrates that CBIs successfully expand screening reach, improve health literacy, and enhance blood pressure control. However, their long-term impact is often limited by poor linkage to formal care and high attrition rates. Success is heavily dependent on trusted community health workers, cultural adaptation, and the use of technology. Conversely, implementation is frequently hindered by resource scarcity, equipment failure, and lack of incentives for the workforce. To maximize effectiveness, future interventions must prioritize sustainable funding, stable supply chains, and better integration with existing health systems. Abbreviations 1. BP Blood Pressure 2. CBIs Community-Based Interventions 3. CHWs Community Health Workers 4. COPD Chronic Obstructive Pulmonary Disease 5. cRCTs Cluster Randomized Controlled Trials 6. CVDs Cardiovascular Diseases 7. HEWs Health Extension Workers 8. HIV Human Immunodeficiency Virus 9. HPV Human Papillomavirus 10. MeSH Medical Subject Headings 11. mHealth Mobile Health 12. NCDs Non-Communicable Diseases 13. PCC Population, Concept, Context 14. PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 15. RCTs Randomized Controlled Trials 16. SCD Sickle Cell Disease 17. SMS Short Message Service 18. VIA Visual Inspection with Acetic Acid 19. WHO World Health Organization Declarations Ethics approval and consent to participate: Not Applicable Consent for publication: Not Applicable Availability of data and materials: Not Applicable Competing interests: All authors declare no competing interests Funding: None Authors' contributions: PMO: Conceptualization, Methodology, Formal Analysis, Investigation (Literature Search), Writing – Original Draft, Writing – Review & Editing. JO : Investigation (Selection of Studies), Project Administration. OLB : Investigation (Data Extraction), Data Curation, Writing- original draft. ASA : Investigation (Data Extraction), Methodology. STB : Investigation (Data Extraction), Validation. JA : Investigation (Data Extraction), Software KYA: Investigation (Selection of studies), Data Curation. PDS : Investigation (Literature Search). POA : Investigation (Data Extraction), writing – original draft. SRM: Investigation (Data Extraction), writing – original draft. Acknowledgements: None Ethics approval and consent to participate Not applicable References Decentralising NCD. management in rural southern Africa: evaluation of a pilot implementation study | BMC Public Health | Full Text [Internet]. [cited 2025 June 29]. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-019-7994-4 Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. The Lancet Global Health [Internet]. 2019 Oct 1 [cited 2025 June 29];7(10):e1295–6. 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BMJ Glob Health [Internet]. 2020 June [cited 2025 Dec 22];5(6):e001959. Available from: https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2019-001959 Additional Declarations No competing interests reported. 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Ghana","correspondingAuthor":false,"prefix":"","firstName":"Shadrach","middleName":"Tetteh","lastName":"Boyetey","suffix":""},{"id":573448835,"identity":"61dec6ec-09e6-478d-b968-cfb4da5c77ab","order_by":5,"name":"Josephine Ampong","email":"","orcid":"","institution":"Kwame Nkrumah University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Josephine","middleName":"","lastName":"Ampong","suffix":""},{"id":573448836,"identity":"6aff18e5-14b8-4a18-a2bf-55289e65160e","order_by":6,"name":"Kareem Yesiru Adeyemi","email":"","orcid":"","institution":"Neuropsychiatric Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kareem","middleName":"Yesiru","lastName":"Adeyemi","suffix":""},{"id":573448837,"identity":"72d0e13f-c559-411e-a1b1-9d693a4a5900","order_by":7,"name":"Paschal D Sedor","email":"","orcid":"","institution":"Komfo Anokye Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Paschal","middleName":"D","lastName":"Sedor","suffix":""},{"id":573448838,"identity":"ac8abd7d-5f2b-4a0a-bdc6-83c0a9454aa9","order_by":8,"name":"Sarah Marion Nakachwa","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"Marion","lastName":"Nakachwa","suffix":""},{"id":573448839,"identity":"e29c969d-622c-4de3-ac9c-ee6dacbe4b76","order_by":9,"name":"Javirah Ahomugisha","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Javirah","middleName":"","lastName":"Ahomugisha","suffix":""},{"id":573448840,"identity":"db002ab6-b1d8-4a89-8fae-81d9a67beb15","order_by":10,"name":"Prince Owusu Adoma","email":"","orcid":"","institution":"University of Education","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"Owusu","lastName":"Adoma","suffix":""}],"badges":[],"createdAt":"2026-01-03 17:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8508373/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8508373/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100141847,"identity":"4823299a-ee8c-4135-b103-a2bc9d05c4f7","added_by":"auto","created_at":"2026-01-13 11:49:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":346205,"visible":true,"origin":"","legend":"","description":"","filename":"CommunitybasedInterventionsNCDS.docx","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/9514d46c09852e672700d645.docx"},{"id":100367125,"identity":"649694c2-c56c-4667-92b8-350ff1ff43c7","added_by":"auto","created_at":"2026-01-16 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11:49:27","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":321685,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/eb25d20c94a9928bc3ef0b68.html"},{"id":100141843,"identity":"4ba8c192-c0f1-43ac-bddd-e5be76f2ed77","added_by":"auto","created_at":"2026-01-13 11:49:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52925,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flowchart of selection of studies\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/7d29981c0405dd64a0f4792f.png"},{"id":100141842,"identity":"c91c13a3-7bd5-45a6-b21e-a40930ac2bc7","added_by":"auto","created_at":"2026-01-13 11:49:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17309,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of included studies across Africa\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/3806c28d2ba7abd4422d4904.png"},{"id":100382176,"identity":"c9a7e162-30cd-4dbb-a50f-f4be9a3c2937","added_by":"auto","created_at":"2026-01-16 10:41:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1857666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/a96fc612-1d83-4479-8625-d7c5d4c08930.pdf"},{"id":100366941,"identity":"6aa080d3-c845-44b0-9ec6-396951daa56a","added_by":"auto","created_at":"2026-01-16 07:56:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14803,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8508373/v1/afee16215dd8afe83e17bb19.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community-based interventions for non-communicable diseases in Africa: A scoping review of scope, effectiveness, and implementation factors","fulltext":[{"header":"1. Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, cancer, and chronic respiratory illnesses are rapidly rising in prevalence across Africa, contributing significantly to morbidity and mortality in both urban and rural settings.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Globally, Cardiovascular diseases account for most NCD deaths, that is \u0026minus;\u0026thinsp;17.9\u0026nbsp;million people annually, followed by cancers (9.3\u0026nbsp;million), respiratory diseases (4.1\u0026nbsp;million), and diabetes (1.5\u0026nbsp;million). NCDs kill 41\u0026nbsp;million people each year globally, and 77% of all NCD deaths are in low- and middle-income countries. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe continent has traditionally grappled with infectious diseases, maternal and child health, nutritional related diseases,[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] but over the years, the morbidity and mortality from NCDs has increased, which the World Health organization (WHO) states a rise from 24% in 2000 to 37% in 2019 deaths caused by NCDS in Africa.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] These places significant pressure on already strained healthcare systems, increasing demand for both acute and chronic care services, especially in urban and poor populations.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eCommunity-based interventions (CBIs) are strategies implemented within specific geographic communities such as neighborhoods, schools, churches, or workplaces with the aim of improving health outcomes. These interventions often use educational, organizational, and policy-level approaches that engage individuals, families, social networks, and institutions. While they may involve community input through advisory groups or coalitions, their primary focus is on influencing individual behavior change, with population-level impact seen as the collective result of these individual changes.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] They are defined by their emphasis on community participation, the involvement of local health workers, and the adaptation of programs to fit cultural and social contexts.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Community based health interventions have shown many positive health outcomes including early detection of NCDs, increased adherence to treatment and modification of lifestyles for prevention.[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere is growing interest in community-based health interventions for the prevention and control of NCDs in Africa, reflecting the urgent need to address the rising burden of these conditions across the continent.[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] While some studies highlight the potential of CBIs such as those involving community health workers, integrated care models, and participatory approaches to improve access to care and support disease management, there is limited understanding of the specific contextual enablers and barriers that influence their success. For example, challenges such as insufficient training, weak inter-sectoral collaboration, inadequate resources, and unclear roles for community health workers have been identified as obstacles to effective implementation. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Additionally, the adaptation of interventions to local cultural, social, and economic contexts is often insufficiently addressed, which can limit both uptake and impact. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGiven the heterogeneity of CBIs and the unique socio-cultural and economic contexts in Africa, a scoping review is appropriate to explore the progress made and gaps in implementing CBIs for NCDs. With this scoping review, we aim to: (1) identify the types of community-based interventions that have been implemented to prevent or manage NCDs among populations in African countries; (2) assess the reported outcomes and effectiveness of these interventions; (3) explore the key facilitators and barriers influencing their implementation; and (4) highlight gaps in the existing literature, particularly in relation to understudied populations, specific NCDs, and geographic regions.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis scoping review followed the methodological framework proposed by Arksey and O\u0026rsquo;Malley, 2005, enhanced by Levac et al., 2010[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and the Joanna Briggs Institute[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It consisted of the following stages (1) identifying the research question(s), (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting results. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] This review protocol was registered on Open Science Framework and available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/4qe76/\u003c/span\u003e\u003cspan address=\"https://osf.io/4qe76/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 1: Identifying the review questions and eligibility criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis was guided by questions developed using the PCC framework (Population, Concept, Context). The main question was:\u003c/p\u003e \u003cp\u003eWhat is the scope of community-based interventions for the prevention and management of NCDs in Africa, including their progress, effectiveness, and gaps\u003cem\u003e?\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe secondary study questions developed using this framework were:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat types of community-based interventions have been implemented to prevent or manage NCDs among populations in African countries\u003cem\u003e?\u003c/em\u003e\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003ePopulation: Individuals or communities in Africa affected by or at risk of NCDs.\u003c/p\u003e \u003cp\u003eConcept: Community-based interventions (e.g., health promotion, screening, self-management).\u003c/p\u003e \u003cp\u003eContext: African countries.\u003c/p\u003e\n\u003ch3\u003e2. What are the reported outcomes and effectiveness of community-based interventions for NCDs in African communities\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e2. What are the reported outcomes and effectiveness of community-based interventions for NCDs in African communities\u003cem\u003e?\u003c/em\u003e\u003c/div\u003e \u003cp\u003ePopulation: Individuals or communities in Africa with or at risk of NCDs\u003c/p\u003e \u003cp\u003eConcept: Outcomes and effectiveness of CBIs (e.g., behavior change, disease control).\u003c/p\u003e \u003cp\u003eContext: African countries.\u003c/p\u003e\n\u003ch3\u003e3. What facilitators and barriers influence the implementation of community-based interventions for NCDs in African settings?\u003c/h3\u003e\n\u003cp\u003ePopulation: Communities and health workers implementing CBIs in Africa.\u003c/p\u003e \u003cp\u003eConcept: Facilitators and barriers to CBI implementation\u003c/p\u003e \u003cp\u003eContext: African countries.\u003c/p\u003e\n\u003ch3\u003e4. What gaps exist in the literature on community-based interventions for NCDs in Africa\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e4. What gaps exist in the literature on community-based interventions for NCDs in Africa\u003cem\u003e?\u003c/em\u003e\u003c/div\u003e \u003cp\u003ePopulation: Individuals or communities in Africa with or at risk of NCDs\u003c/p\u003e \u003cp\u003eConcept: Gaps in CBI research (e.g., lack of data on specific NCDs or intervention types).\u003c/p\u003e \u003cp\u003eContext: African countries.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEligibility criteria.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEligibility criteria defined using the PCC framework:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePopulation\u003c/strong\u003e \u003cp\u003eIndividuals or communities in African countries affected by or at risk of NCDs (e.g., cardiovascular diseases, diabetes, cancer, chronic respiratory diseases). Studies focusing on children, adolescents, adults, or older adults will be included. No restrictions on age, gender, or socio-economic status.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConcept\u003c/strong\u003e \u003cp\u003eCommunity-based interventions for NCD prevention or management. CBIs are defined as health promotion, prevention, or management programs delivered in community settings (e.g., villages, neighborhoods, schools, faith-based organizations) involving community members, community health workers, or local organizations. Interventions may include health education, screening, lifestyle modification, or self-management programs.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eContext\u003c/strong\u003e \u003cp\u003eStudies conducted in any African country (as defined by the African Union\u0026rsquo;s 54 member states). Studies from urban, rural, or peri-urban settings in Africa will be included. Global or multi-country studies will be included only if they provide specific data for African countries.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePeer-reviewed articles published in English.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePrimary Studies published from 2000 to 2nd July 2025 (last date of search)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQualitative, quantitative, or mixed-methods studies reporting on CBIs for NCDs in Africa.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies addressing intervention design, implementation, outcomes, facilitators, barriers, or gaps.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies focusing solely on communicable diseases or non-community-based interventions (e.g., hospital-based care).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies conducted outside Africa or lacking Africa-specific data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSecondary studies, editorials, protocols, commentaries, or opinion pieces without empirical data\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 2: Identification of studies\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA comprehensive search strategy developed following the JBI three step framework.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] First, a preliminary search was initiated using selected keywords. The titles and abstracts of the retrieved articles were analyzed to uncover relevant synonyms, related terms, and indexing language. To ensure comprehensive coverage, Medical Subject Headings (MeSH) and other controlled vocabularies were explored. The developed search strategy was subsequently be refined and validated.\u003c/p\u003e \u003cp\u003eSecondly, a full search was conducted across three databases (Pubmed, Scopus and Web of Science) and lastly, the results were screened for duplicates. The search strategy for each database is provided in supplementary file 1.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 3: Selection of studies\u003c/b\u003e \u003c/p\u003e \u003cp\u003eArticles were selected against inclusion and exclusion criteria using rayyan software.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Two reviewers PMO and JO independently screen all titles and abstracts to evaluate their relevance according to the predefined inclusion criteria. Studies potentially eligible underwent full-text review by the same reviewers, who assessed them thoroughly against the same criteria. Any disagreements encountered during the screening or full-text review phases were addressed through discussion, and if consensus wasn\u0026rsquo;t reached, a third reviewer KYA resolved the conflict. The full search and selection process, including the number of records at each stage was summarized using a PRISMA flowchart.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 4: Data extraction and charting\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Data from the included studies was systematically extracted using a standardized charting form developed and pilot-tested by the review team. This form captured key details such as authorship, year, country, study design, sample size, setting, and population characteristics. It also included information on the type and delivery of community-based interventions, duration, stakeholders involved, and reported effectiveness and outcomes, including health and behavioral changes. Additionally, data on implementation factors such as facilitators, barriers. All included articles were subjected to double data extraction by two reviewers independently, and a 3rd reviewer compared both extractions for any discrepancies and completeness which were resolved.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStep 5: Data synthesis, collating and reporting the results\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDescriptive statistics of frequency and percentage were used to summarize the study characteristics. A map showing the distribution of included studies was created using RStudio Version 2025.05.1\u0026thinsp;+\u0026thinsp;513.\u003c/p\u003e \u003cp\u003eA narrative synthesis was used to summarize the results of the included studies into themes in alignment with the review questions, allowing for a structured description of the types, scope, and implementation of community-based interventions for NCDs in Africa.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Characteristics\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 Study Selection.\u003c/h2\u003e \u003cp\u003eA total of 5381 studies were retrieved of which 91 were included in thematic synthesis as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Distribution of studies\u003c/h2\u003e \u003cp\u003eFifteen countries were represented with South Africa (n\u0026thinsp;=\u0026thinsp;20), Kenya (n\u0026thinsp;=\u0026thinsp;19), Uganda (n\u0026thinsp;=\u0026thinsp;16), Nigeria (n\u0026thinsp;=\u0026thinsp;11) and Ethiopia (n\u0026thinsp;=\u0026thinsp;7) accounting for most of the studies. 1 study was multi-country (Uganda and Kenya). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of these studies by country.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Study Designs and Methodologies\u003c/h2\u003e \u003cp\u003eThe largest proportion of studies utilized qualitative designs (n\u0026thinsp;=\u0026thinsp;24), including phenomenological approaches, focus group discussions, and in-depth interviews, primarily to explore the feasibility, acceptability, and implementation context of these programs. Mixed-methods studies (n\u0026thinsp;=\u0026thinsp;16) were also prominent, often combining screening data with qualitative inquiry to provide a holistic view of intervention impact. Evaluative research was well-represented by quasi-experimental designs (n\u0026thinsp;=\u0026thinsp;17), such as pre-post intervention studies, and experimental designs, including Cluster Randomized Controlled Trials (cRCTs) and pilot RCTs (n\u0026thinsp;=\u0026thinsp;9). The remaining consisted of observational studies (n\u0026thinsp;=\u0026thinsp;8) such as cross-sectional surveys, prospective cohorts, and diagnostic accuracy studies alongside a smaller subset of general pilot/feasibility studies (n\u0026thinsp;=\u0026thinsp;5) and cost-effectiveness analyses (n\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003cp\u003eThe majority of studies evaluated active interventions, a subset (n\u0026thinsp;=\u0026thinsp;6) utilized observational or formative designs to assess existing community structures or feasibility without deploying a new program\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.1.4 Target NCDS\u003c/h2\u003e \u003cp\u003eThe community-based interventions included in this review addressed a wide, though uneven, spectrum of NCDs. Cardiovascular Diseases (CVDs) were the most studied group, with Hypertension targeted 36 times (including combinations with other conditions), Stroke 2 times, and general CVD risk factors 5 times. Cancers were addressed in a total of 19 studies. This focus was highly specific, dominated by Cervical Cancer in 16 instances (including 3 combined with breast cancer), with only Breast Cancer alone targeted 1 time, and Prostate Cancer 1 time. Diabetes was addressed in 17 studies, with Diabetes and Hypertension combined 10 times, and Diabetes Mellitus (Type 1 and/or Type 2) exclusively 6 times. Mental and Neurological Disorders were targeted 15 times, covering Dementia (4 instances), Psychotic Disorders (2 instances), Postpartum/Perinatal Mental Disorders (2 instances), and Autism/Developmental Disorders (2 instances). Other conditions receiving minimal attention included Chronic Respiratory Diseases (Asthma and COPD, 2 instances), Pregnancy-related Hypertensive Disorders (2 instances), and Sickle Cell Disease (SCD) (1 instance). Seven studies also focused on broad NCD Risk Factors/General NCDs.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Types of Community-Based Interventions\u003c/h2\u003e \u003cp\u003eWe identified a wide array of community-based interventions (CBIs) ranging from targeted screening campaigns to comprehensive, multi-component disease management programs. These are depicted in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Screening and Early Detection Strategies\u003c/h2\u003e \u003cp\u003eScreening was the most predominant intervention type, implemented through two primary delivery models: door-to-door household visits and mass community campaigns.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDoor-to-Door Screening\u003c/strong\u003e \u003cp\u003eCommunity Health Workers (CHWs) and Health Extension Workers (HEWs) were deployed to households to measure vital signs and carry out simple tests. This approach was widely used for hypertension and diabetes, utilizing portable electronic blood pressure monitors and glucometers[\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Specialized home-based screening was also employed for dementia and cognitive impairment [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] as well as for COPD using lung function questionnaires and peak flow meters[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCampaigns and Health Fairs\u003c/strong\u003e \u003cp\u003eOther interventions utilized high-throughput screening at central locations such as markets, schools, and places of worship. These included multi-disease \u0026ldquo;Community Health Campaigns\u0026rdquo;[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], church-based screenings for psychological distress[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and comparative studies evaluating home-based and community strategies[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCancer Screening Innovations\u003c/strong\u003e \u003cp\u003eInterventions for cervical cancer heavily utilized task-shifting. Strategies included training CHWs to conduct Visual Inspection with Acetic Acid (VIA\u003cb\u003e)\u003c/b\u003e[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] and the distribution of self-sampling kits for HPV to increase privacy and uptake[\u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Health Education and Health Promotion\u003c/h2\u003e \u003cp\u003eEducational interventions aimed to improve health literacy and modify risk behaviors using culturally adapted delivery methods.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGroup and Peer-Based Learning\u003c/strong\u003e \u003cp\u003eStructured group sessions were common, such as the \"Lifestyle Africa\" diabetes prevention program[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], community health clubs[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and supervised community exercise sessions[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInnovative Communication\u003c/strong\u003e \u003cp\u003eNovel approaches included the use of applied drama and theatre to share patient stories[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] and the use of a \"story-telling cloth\" (textile) to facilitate community dialogue on health topics[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTargeted Counseling\u003c/strong\u003e \u003cp\u003eSpecific programs targeted deeply ingrained beliefs, such as education to counter fatalistic views on prostate cancer[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] or integrated health messaging into traditional marriage counseling[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGeneral Awareness\u003c/strong\u003e \u003cp\u003eBroader awareness campaigns utilized radio, social media, and beating\" traditional community announcements alongside CHW outreach[\u003cspan additionalcitationids=\"CR54 CR55 CR56\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Integrated Management and Linkage to Care\u003c/h2\u003e \u003cp\u003eBeyond screening, several interventions established comprehensive care models to bridge the gap between community detection and clinical treatment.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTask-Sharing and Home-Based Care\u003c/strong\u003e \u003cp\u003eThese programs shifted clinical tasks to lay workers. Examples include CHWs delivering medications directly to patients\u0026rsquo; homes[\u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] conducting post-discharge rehabilitation for stroke survivors[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], and managing mental health cases after training in identification and referral[\u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLinkage Strategies\u003c/strong\u003e \u003cp\u003eTo ensure screen-positive individuals reached facilities, interventions employed referral vouchers, SMS reminders for appointments, and \"screen-and-treat\" models where VIA positive women received same-day thermocoagulation treatment in the village[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSelf-Management Support\u003c/strong\u003e \u003cp\u003eInterventions empowered patients to manage their conditions through home blood pressure monitoring combined with CHW coaching on diet and adherence[\u003cspan additionalcitationids=\"CR66 CR67\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.2.4 mHealth and Technology Enablers\u003c/h2\u003e \u003cp\u003eTechnology was employed in multiple intervention types. Mobile health (mHealth) tools were used for data collection and decision support, such as the \u003cem\u003eAfyaChat\u003c/em\u003e app for CVD risk assessment[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e], tablet-based dementia screening[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and smartphone-guided referrals[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR70\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. Additionally, telehealth models enabled CHWs to connect patients in remote villages with clinicians via video for real-time consultations[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Community-Based Interventions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Implementors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDelivery Methods \u0026amp; Study Examples\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScreening \u0026amp; Early Detection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHWs, HEWs, Nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eDoor-to-door\u003c/b\u003e: BP/Glucose checks[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] Cognitive screening[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] COPD checks[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], Prenatal depression screening[\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cb\u003eCampaigns\u003c/b\u003e: Church screenings[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], Cervical cancer outreach[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cb\u003eSelf-Testing\u003c/b\u003e: HPV self-sampling[\u003cspan additionalcitationids=\"CR42 CR43\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Education \u0026amp; Promotion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHWs, Volunteers, Peers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e: Lifestyle workshops[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], Exercise classes[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], Health clubs[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cb\u003eOne-on-One\u003c/b\u003e: Household counseling[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e\u003cb\u003eCreative\u003c/b\u003e: Drama/Theatre[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], Story-telling cloth[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], Marriage counseling[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntegrated Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHWs, HSAs, Pharmacists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMedication Delivery\u003c/b\u003e: Home delivery of meds by CHWs[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003e\u003cb\u003eLinkage\u003c/b\u003e: Referral vouchers[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], SMS reminders[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cb\u003eClinical Care\u003c/b\u003e: \"Screen-and-Treat\" (VIA\u0026thinsp;+\u0026thinsp;Thermocoagulation)[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], Home-based stroke rehab[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], Mental health integration[\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emHealth \u0026amp; Digital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHWs, Research Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTools\u003c/b\u003e: Smartphone risk assessment[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], Telehealth consultations[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], Tablet-based data collection[\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Outcomes and Effectiveness of Community-Based Interventions\u003c/h2\u003e \u003cp\u003eThe review identified 86 studies reporting intervention outcomes, providing mixed but largely positive evidence regarding the utility of community-based interventions (CBIs). While these programs consistently demonstrated high effectiveness in expanding screening reach and improving health literacy, the impact on long-term clinical outcomes and linkage to formal care was variable, often influenced by the intensity of the intervention and health system capacity.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Clinical Health Outcomes\u003c/h2\u003e \u003cp\u003eEvidence regarding the impact of CBIs on physiological health outcomes was predominantly positive for hypertension control. Multiple interventions reported statistically significant reductions in systolic and diastolic blood pressure, with decreases ranging from 2.75 mmHg to over 24 mmHg compared to control groups[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Correspondingly, several studies demonstrated that community-based care significantly increased hypertension control rates[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e], and one cost-effectiveness analysis found that \"step-down\" medication dosing by CHWs maintained blood pressure control while reducing costs[\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. However, the evidence was not unequivocal; a subset of studies found no statistically significant difference in blood pressure reduction between intervention and control arms[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e], or found effects only in specific sub-groups such as younger adults[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResults for other conditions were similarly mixed. For diabetes, home delivery of medication was associated with improved glycemic control[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], yet one study found that patients receiving standard clinic care achieved better outcomes than those in the community arm[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of stroke rehabilitation, home-based care significantly improved functional independence scores[\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e], although mortality and residual disability remained high [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Furthermore, One community engagement study for preeclampsia found no significant reduction in composite maternal/newborn mortality despite increased contacts[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. A community based rehabilitation for Schizophrenia was acceptable, and improved functioning of patients[\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Screening Reach and Diagnostic Accuracy\u003c/h2\u003e \u003cp\u003eA primary strength of CBIs was their ability to expand access to diagnosis. Interventions successfully reached large populations, identifying high rates of undiagnosed conditions such as hypertension, diabetes, and cervical cancer[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Community mobilization strategies, including mass campaigns and innovative \"story-telling\" approaches, led to substantial increases in screening uptake, with some studies reporting up to a five-fold increase[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e]. Self-sampling models for HPV were particularly effective, achieving high participation rates due to increased privacy[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e], though participation in some campaigns declined over time due to community rumors[\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. When standardized tools were utilized, task-shifting to lay workers generally yielded acceptable diagnostic accuracy. Health Extension Workers (HEWs) and CHWs achieved high sensitivity and specificity for hypertension[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and mental health screening[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, accuracy was not uniform; some studies reported low specificity leading to over-referral [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], or poor diagnostic capability when CHWs worked without supervision[\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cb\u003eLinkage to Care and Retention\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSome interventions achieved high linkage rates (above 80%) within six months, particularly when referrals were made to nearby primary health facilities and when demographic and social predictors favored access[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, despite high screening yields, linkage to formal care remained a critical bottleneck in the care cascade. Numerous studies observed a \"leakage\" effect, where high screening numbers did not translate into sustained treatment; linkage rates frequently fell way below the screened numbers. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan additionalcitationids=\"CR89\" citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e], and loss to follow-up was also reported. [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eBehavioral, Knowledge, and Stigma Outcomes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBeyond clinical metrics, CBIs were highly effective in modifying health beliefs and increasing literacy. Educational interventions consistently led to statistically significant increases in knowledge regarding cervical cancer symptoms and risk factors[\u003cspan additionalcitationids=\"CR92 CR93\" citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e], diabetes management[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], and general NCD awareness[\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e, \u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e]. Furthermore, these programs successfully targeted deep-seated stigma. Interventions significantly reduced fatalistic beliefs regarding prostate cancer[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and decreased social distance towards marginalized groups, including children with autism[\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e] and people with dementia[\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e] or psychosis[\u003cspan citationid=\"CR97\" class=\"CitationRef\"\u003e97\u003c/span\u003e]. While knowledge improved, behavioral changes were more complex; some studies reported reductions in physical inactivity[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], while others found no significant improvements in body mass index or obesity despite lifestyle counseling[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cb\u003eFeasibility and Cost-Effectiveness\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFinally, qualitative and process data highlighted the viability of these models. Most interventions were deemed feasible and acceptable by communities, including those utilizing mHealth tools[\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e] or home-based care models[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan additionalcitationids=\"CR100 CR101\" citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e]. Where assessed, economic analyses consistently found CBIs to be cost-effective or cost-saving, with favorable incremental cost-effectiveness ratios[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], suggesting they represent a \"good buy\" for health systems in low-resource settings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Facilitators and Barriers to Implementation\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Health System and Workforce Factors\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFacilitators\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe most consistent enabler across studies was the trust and familiarity of the workforce. Community Health Workers (CHWs) were frequently described as trusted \"village doctors,\" neighbors, or \"sons of the soil,\" which facilitated entry into households and improved acceptability [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR103\" class=\"CitationRef\"\u003e103\u003c/span\u003e]. Task-shifting was feasible when supported by structured training; effective strategies included the use of simple, standardized tools (e.g., \"pocket guides,\" aneroid BP machines) and video-based training modules[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Integration with existing services was another key success factor; embedding NCD care into HIV platforms, mental health services, or church activities improved feasibility and reduced duplication [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e]. Availability of inputs, support supervision and training of CHWs were also reported enablers.[\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eHowever, the workforce was often unsupported. A major barrier was resource scarcity, particularly the stockouts of equipments and supplies for use in the community and at referral clinics.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e]. Equipment failure was rampant, with reports of broken blood pressure machines and dead batteries halting screening efforts[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR99\" class=\"CitationRef\"\u003e99\u003c/span\u003e, \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e]. Systemic issues included staff shortages and inadequate supervision; some studies noted that CHWs received little feedback from facility health professionals [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR105\" class=\"CitationRef\"\u003e105\u003c/span\u003e]. Furthermore, CHW workload and lack of financial incentives were critical challenges, with volunteers often overburdened by vast catchment areas and the \"opportunity costs\" of unpaid work[\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR100\" class=\"CitationRef\"\u003e100\u003c/span\u003e, \u003cspan citationid=\"CR104\" class=\"CitationRef\"\u003e104\u003c/span\u003e, \u003cspan additionalcitationids=\"CR107\" citationid=\"CR106\" class=\"CitationRef\"\u003e106\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e], Lack of confidence in their personal abilities, lack of training and limited health system support were also reported by CHWs.[\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]. CHWs knowledge gaps were also reported.[\u003cspan citationid=\"CR110\" class=\"CitationRef\"\u003e110\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Community and Socio-Cultural Factors\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFacilitators\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eInterventions succeeded when they were culturally adapted. The use of local languages[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e] and the involvement of community leaders, traditional chiefs, and religious figures[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR101\" class=\"CitationRef\"\u003e101\u003c/span\u003e] were vital for gaining entry and endorsement. Peer support and group dynamics were also beneficial, fostering a sense of shared experience and reducing isolation[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eDeeply ingrained beliefs and stigma posed significant hurdles. Patients frequently attributed symptoms (such as those of dementia, stroke, or mental illness) to witchcraft or supernatural causes rather than medical conditions[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR102\" class=\"CitationRef\"\u003e102\u003c/span\u003e, \u003cspan citationid=\"CR111\" class=\"CitationRef\"\u003e111\u003c/span\u003e]. Stigma was a specific barrier for mental health and smoking-related conditions[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR109\" class=\"CitationRef\"\u003e109\u003c/span\u003e]. Gender dynamics played a restrictive role; studies reported that women often required spousal permission to access care. Husband disapproval or \"male partner resistance\" was a specific, recurring barrier to cervical cancer screening and HPV self-sampling[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Additionally, community rumors (e.g., fears of uterus removal or \"spies\") and lack of awareness occasionally hindered interventions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]. Low community trust and lack of interest was also an issue[\u003cspan citationid=\"CR108\" class=\"CitationRef\"\u003e108\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3 Logistical and Economic Factors\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFacilitators\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eProximity was the strongest logistical enabler. Home-based (door-to-door) screening and \"screen-and-treat\" models removed the need for travel, significantly boosting uptake[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e]. Technology (mHealth) served as a powerful tool for standardizing care and guiding referrals, provided devices were functional and charged[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e, \u003cspan citationid=\"CR98\" class=\"CitationRef\"\u003e98\u003c/span\u003e, \u003cspan citationid=\"CR112\" class=\"CitationRef\"\u003e112\u003c/span\u003e]. Economic incentives, such as transport vouchers, were crucial for converting screening into linkage[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eBarriers\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eConversely, poverty was the overarching structural barrier. The cost of transport to referral facilities was frequently cited as the primary reason for loss to follow-up[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. Even when screening was free, the cost of treatment or vaccines prevented effective care[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR113\" class=\"CitationRef\"\u003e113\u003c/span\u003e]. Migration and mobility (e.g., participants relocating for work) disrupted continuity of care[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. Finally, the asymptomatic nature of NCDs led to complacency, with many patients \"feeling well\" and thus deprioritizing clinic visits[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWe conducted a scoping review to map the scope, effectiveness, facilitators and barriers to implementation of CBIs targeting NCDs in Africa. Our review revealed evidence of CBIs across 15 African countries, with South Africa, Kenya, Uganda, and Nigeria accounting for most of the studies.\u003c/p\u003e \u003cp\u003eThis implies that we found no evidence in about 39 of the 54 countries classified among African countries. This finding suggests geographically concentrated research on community-based NCD interventions in Africa, with South Africa, Kenya, Uganda, and Nigeria dominating the literature. Similar geographic concentration has been observed in previous reviews examining the sustainability of health interventions in sub-Saharan Africa, where Kenya and Nigeria had the most representation[\u003cspan additionalcitationids=\"CR115\" citationid=\"CR114\" class=\"CitationRef\"\u003e114\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR116\" class=\"CitationRef\"\u003e116\u003c/span\u003e]. This observation is concerning since NCDs represent an expanding burden across all African countries and require evidence-based community interventions tailored to their diverse contexts.\u003c/p\u003e \u003cp\u003eWe also found variations in intervention effectiveness across different NCDs and implementation contexts. Hypertension interventions demonstrated the most consistent positive outcomes, with community-based approaches showing reduction in both systolic and diastolic blood pressure, though the evidence base remains inconsistent. Self-sampling models for cervical cancer screening worked well, but the results for mental health and diabetes management were less consistent, depending on how much help CHWs gave and how easy it was to obtain medications at referral facilities. This variation in effectiveness requires contextualized approaches that account for specific disease characteristics, healthcare system capacities, and community preparedness. Previous literature highlighted that priorities for disease management in primary care include the availability of essential diagnostic tools and medications at local primary healthcare clinics, along with standard protocols for diagnosis, treatment, monitoring, and referral to specialist care[\u003cspan citationid=\"CR117\" class=\"CitationRef\"\u003e117\u003c/span\u003e]. Our findings confirm that CBI interventions performed better when these foundational elements were in place.\u003c/p\u003e \u003cp\u003eKey facilitators were rooted in the local context. The trusted status of CHWs was repeatedly cited: community members viewed Health Extension Workers or CHWs as \u0026ldquo;family\u0026rdquo; or \u0026ldquo;neighbours,\u0026rdquo; enhancing participation and adherence. Programs that leveraged the trust of community health workers viewed as neighbours or \u0026lsquo;one of us\u0026rsquo; reported higher participation and adherence in screening activities and other health behaviors.[\u003cspan citationid=\"CR118\" class=\"CitationRef\"\u003e118\u003c/span\u003e] Studies show that CHWs improve health knowledge and community care-seeking, acting as a bridge to formal services. Formal training and supervision also mattered: interventions that gave CHWs clear protocols, simple tools (BP cuffs, flipcharts), and ongoing support reported better performance. Integration into existing structures (e.g. piggybacking on HIV or maternal health platforms, involving local leaders and clinics) further anchored programs in the health system and community networks. On the socio-cultural side, tailoring messages to local languages and engaging traditional authorities or peer groups proved critical to acceptance, as did framing health behaviors in culturally relevant ways. Formal training, ongoing supervision and logistical support (including simple tools) are linked to higher CHW performance and community acceptance.[\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eConversely, barriers frequently undermined impact. Health system constraints loomed large: many programs reported shortages of supplies (e.g. broken BP machines, depleted testing kits) and erratic drug availability, often halting services mid-stream. Workforce issues were also a problem \u0026ndash; overworked, unpaid CHWs sometimes lost motivation. These issues echo known challenges in African health systems[\u003cspan citationid=\"CR119\" class=\"CitationRef\"\u003e119\u003c/span\u003e] and imply policy remedies: stable funding and supply chains for NCD programs are needed, and CHW programs must include incentives or career pathways to sustain motivation. Socio-economic hurdles were also critical. Poverty and transport costs consistently impeded care: even when screening was free, many diagnosed individuals could not afford repeated clinic visits or medications.[\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e] This suggests policy fixes such as travel vouchers or decentralizing treatment (e.g. home drug delivery) can meaningfully improve linkage to care. Cultural factors too created barriers: in some communities, illnesses (especially mental/cognitive ones) were attributed to witchcraft or spirits engendering stigma. Deep-rooted cultural beliefs and mistrust in health programs can limit engagement, particularly where traditional health systems and explanations of illness differ.[\u003cspan citationid=\"CR120\" class=\"CitationRef\"\u003e120\u003c/span\u003e] Gender norms were relevant in women\u0026rsquo;s health for instance, cervical cancer outreach faltered when husbands disapproved. Addressing these requires culturally sensitive strategies: involving community leaders, providing couple\u0026rsquo;s education or male outreach, and sustained community dialogue can help overcome fatalism and mistrust.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplication for Practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe review study included interventions from African countries where most clients with NCDs still present late or remain undiagnosed, thus increasing the morbidity and mortality associated with NCDs in Africa. Screening through door-to-door visits and community campaigns is one way to find undiagnosed NCDs early, but clinical exams and lab tests give more certain diagnoses[\u003cspan citationid=\"CR121\" class=\"CitationRef\"\u003e121\u003c/span\u003e, \u003cspan citationid=\"CR122\" class=\"CitationRef\"\u003e122\u003c/span\u003e] This approach assumes that people who are screened will be able to get to health facilities, but our research showed that many people who test positive never get treatment. Fundamental drivers of successful CHW programs include structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training[\u003cspan citationid=\"CR123\" class=\"CitationRef\"\u003e123\u003c/span\u003e, \u003cspan citationid=\"CR124\" class=\"CitationRef\"\u003e124\u003c/span\u003e] Our findings showed that some interventions were able to achieve blood pressure control, improve glycaemic management, and benefit from rehabilitation through consistent CHW support when these elements were present. It implies that comprehensive training on screening, referral, and follow-up will have a substantial impact, especially when CHWs are equipped with functional tools, provided regular supervision, and compensated fairly for their work. When communities are mobilized effectively, individuals receive regular screenings using validated tools, and referral systems provide transport support and same-day treatment options when feasible, early detection can lead to timely care, thereby reducing morbidity and mortality associated with NCDs. Our review showed most interventions were deemed feasible and acceptable by communities. Therefore, intensive public and institutional education, combined with strengthened referral systems, is required to maximize the impact of community-based NCD interventions, aiming for early detection, successful linkages to care, and sustained treatment adherence.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for Research\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur study highlights geographic concentration in research on community-based interventions for NCDs in Africa, with limited studies from Francophone and Lusophone countries. Most interventions addressed hypertension and cervical cancer, but fewer covered diabetes, chronic respiratory diseases, and mental health. We hope this study spurs research on under-represented NCDs and countries, where NCDs are also rising. We recommend primary studies evaluating the long-term sustainability and cost-effectiveness of CBIs beyond pilot phases. Sustainability research stresses ongoing benefits after funding ends, continued programme activities post-withdrawal, and community empowerment to sustain efforts.[\u003cspan citationid=\"CR125\" class=\"CitationRef\"\u003e125\u003c/span\u003e, \u003cspan citationid=\"CR126\" class=\"CitationRef\"\u003e126\u003c/span\u003e] We also urge studies on the best training for community health workers, compensation, and supervision to ensure quality and retention. Strong leadership and alignment with government priorities improve success, so research on policy integration and health system readiness is needed.\u003c/p\u003e \u003cp\u003eFurther, a systematic review and meta-analysis could quantify the pooled effectiveness of intervention components across NCD categories in African settings. Studies on factors enabling linkage to care after community screening would address observed \"leakage\" in the care cascade. Most included studies were pilots with short follow-ups. There is the need for long-term evaluations and implementation research to scale sustainable CBIs across diverse African health systems. Finally, equity considerations were insufficiently explored, with few studies examining differential effects across gender, socioeconomic status, rurality, or marginalized populations. Contextual factors like health financing, political stability, and urban-rural differences, which influence success, were not systematically examined. Therefore, further studies should explore this.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths and Limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e This scoping review is likely the first to map community-based NCD interventions comprehensively across Africa. It reveals geographic concentration in South Africa, Kenya, Uganda, and Nigeria, alongside evidence gaps elsewhere. Our methods enabled systematic article identification, intervention charting, and outcome analysis across NCDs. However, our study is limited by its diverse study designs (observational and experimental), yielding variable evidence quality. No formal quality appraisal was done, consistent with scoping reviews, but its absence restricted the assessment of robustness. We searched 3 databases; studies in other databases may have been missed; future work should expand searches. The review we conducted covered only English publications and only non-English ones with available translations, potentially excluding French, Portuguese, or other-language studies, especially from Francophone and Lusophone Africa. Grey literature or alternative terms may also have been overlooked, despite broad search strategies. Detailed meta-analysis for precise effect sizes was beyond scope\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCommunity-based interventions are an effective strategy for addressing the rising burden of NCDs in Africa. This review demonstrates that CBIs successfully expand screening reach, improve health literacy, and enhance blood pressure control. However, their long-term impact is often limited by poor linkage to formal care and high attrition rates. Success is heavily dependent on trusted community health workers, cultural adaptation, and the use of technology. Conversely, implementation is frequently hindered by resource scarcity, equipment failure, and lack of incentives for the workforce. To maximize effectiveness, future interventions must prioritize sustainable funding, stable supply chains, and better integration with existing health systems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e1. \u003cb\u003eBP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e2. \u003cb\u003eCBIs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity-Based Interventions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e3. \u003cb\u003eCHWs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Health Workers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e4. \u003cb\u003eCOPD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e5. \u003cb\u003ecRCTs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCluster Randomized Controlled Trials\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e6. \u003cb\u003eCVDs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e7. \u003cb\u003eHEWs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Extension Workers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e8. \u003cb\u003eHIV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e9. \u003cb\u003eHPV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Papillomavirus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e10. \u003cb\u003eMeSH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Subject Headings\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e11. \u003cb\u003emHealth\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMobile Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e12. \u003cb\u003eNCDs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-Communicable Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e13. \u003cb\u003ePCC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePopulation, Concept, Context\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e14. \u003cb\u003ePRISMA-ScR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePreferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e15. \u003cb\u003eRCTs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomized Controlled Trials\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e16. \u003cb\u003eSCD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSickle Cell Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e17. \u003cb\u003eSMS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort Message Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e18. \u003cb\u003eVIA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Inspection with Acetic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e19. \u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eAll authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePMO:\u003c/strong\u003e Conceptualization, Methodology, Formal Analysis, Investigation (Literature Search), Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing. \u003cstrong\u003eJO\u003c/strong\u003e: Investigation (Selection of Studies), Project Administration. \u003cstrong\u003eOLB\u003c/strong\u003e: Investigation (Data Extraction), Data Curation, Writing- original draft. \u003cstrong\u003eASA\u003c/strong\u003e: Investigation (Data Extraction), Methodology. \u003cstrong\u003eSTB\u003c/strong\u003e: Investigation (Data Extraction), Validation. \u003cstrong\u003eJA\u003c/strong\u003e: Investigation (Data Extraction), Software \u003cstrong\u003eKYA:\u0026nbsp;\u003c/strong\u003eInvestigation (Selection of studies), Data Curation. \u003cstrong\u003ePDS\u003c/strong\u003e: Investigation (Literature Search). \u003cstrong\u003ePOA\u003c/strong\u003e: Investigation (Data Extraction), writing \u0026ndash; original draft. \u0026nbsp;\u003cstrong\u003eSRM:\u003c/strong\u003e Investigation (Data Extraction), writing \u0026ndash; original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDecentralising NCD. management in rural southern Africa: evaluation of a pilot implementation study | BMC Public Health | Full Text [Internet]. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2025.1687963/full\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2025.1687963/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlor LS, Wilson S, Bhatt P, Bryant M, Burnett A, Camarda JN, Chakravarthy V, Chandrashekhar C, Chaudhury N, Cimini C, Colombara DV, Narayanan HC, Cortes ML, Cowling K, Daly J, Duber H, Ellath Kavinkare V, Endlich P, Fullman N, Gabert R, Glucksman T, Harris KP, Loguercio Bouskela MA, Maia J, Mandile C, Marcolino MS, Marshall S, McNellan CR, Medeiros DSD, Mistro S, Mulakaluri V, Murphree J, Ng M, Oliveira JAQ, Oliveira MG, Phillips B, Pinto V, Polzer Ngwato T, Radant T, Reitsma MB, Ribeiro AL, Roth G, Rumel D, Sethi G, Soares DA, Tamene T, Thomson B, Tomar H, Ugliara Barone MT, Valsangkar S, Wollum A, Gakidou E. Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA. BMJ Glob Health [Internet]. 2020 June [cited 2025 Dec 22];5(6):e001959. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gh.bmj.com/lookup/doi/10.1136/bmjgh-2019-001959\u003c/span\u003e\u003cspan address=\"https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2019-001959\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Non-communicable diseases, community-based interventions, community engagement, effectiveness, facilitators, barriers","lastPublishedDoi":"10.21203/rs.3.rs-8508373/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8508373/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe increase of non-communicable diseases (NCDs) across Africa has become a major public health concern, contributing to significant morbidity and mortality which exerts significant strain on the already burdened health systems. Community-based interventions (CBIs) offer a strategy to address these diseases but evidence remains scattered on their effectiveness, contextual factors that enable or hinder their implementation. This review aims to map existing community-based interventions, assess their outcomes, identify key facilitators and barriers, and highlight gaps in the literature across diseases, populations, and regions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched PubMed, Scopus and Web of Science to identify studies. Results were synthesized thematically and reported using a narrative approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis review analyzed 91 studies from across Africa, with most conducted in South Africa, Kenya, Uganda, and Nigeria, focusing on community-based interventions for NCDs. The interventions addressed screening, health promotion, integrated care, and Health, targeting mainly hypertension, diabetes, cancers, and mental and neurological disorders. Overall, CBIs enhanced screening, health literacy, and selected clinical outcomes, especially blood pressure control, although continuity and linkage to formal care were inconsistent. Key facilitators included trusted community health workers and culturally tailored approaches, task-shifting, proximity to people, and use of digital technologies while limited resources, poverty, stigma, and fragile health systems posed major challenges.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCommunity-based interventions for NCDs in Africa demonstrate huge potential to counter the rising NCD burden but encounter significant challenges; successful implementation requires resource sensitive and cultural tailored strategies.\u003c/p\u003e","manuscriptTitle":"Community-based interventions for non-communicable diseases in Africa: A scoping review of scope, effectiveness, and implementation factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 11:49:22","doi":"10.21203/rs.3.rs-8508373/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-09T08:31:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T18:45:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T09:52:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177384631835235381102885277441941114951","date":"2026-01-20T15:45:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24474100100584357706783804989537038387","date":"2026-01-20T10:01:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31758099179308339493867065685747835770","date":"2026-01-20T09:03:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-17T13:56:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51132949106440001921051527608900662107","date":"2026-01-12T17:27:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-12T11:14:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-06T08:50:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T10:07:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-05T10:01:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-01-03T17:10:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf72e6db-0ff8-4fbf-9e07-f085d9051c22","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T08:40:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 11:49:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8508373","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8508373","identity":"rs-8508373","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}