Using implementation science for WHO noncommunicable disease technical packages in low-and middle-income countries: a scoping review.

Introduction: The World Health Organization (WHO) created technical packages to support countries in preventing and treating noncommunicable diseases (NCDs). While these packages provide evidence-informed guidance for prevention, detection, and management of NCDs, little is known about how implementation science concepts and methods have been used in their adoption and scale-up in low- and middle-income countries (LMICs). This scoping review examines how implementation and dissemination science have been used across WHO NCD technical packages and the extent to which these efforts align with national NCD strategies. Methods: We conducted a scoping review of peer-reviewed literature (2009-2023) on the implementation or adaptation of WHO technical packages for the prevention and control of NCDs, in LMICs. Eight databases were searched. Data were extracted on use of implementation frameworks, barriers and facilitators, stakeholder engagement, capacity-building strategies, implementation outcomes, and sustainability. Findings were organized using domains aligned with the Expert Recommendations for Implementing Change (ERIC) framework. Results: and discussion: Fifty-seven studies from 27 LMICs met inclusion criteria. Most examined PEN or PEN-Plus, followed by HEARTS and MPOWER. Only one study explicitly applied a formal implementation science framework, and few explicitly reported using a conceptual mode or framework to guide implementation or evaluation. Stakeholder engagement was described inconsistently and mostly limited to providers and programme managers. Barriers reported commonly related to limited medicines, diagnostics, workforce capacity, and weak information systems, while facilitators included standardized protocols, team-based care, and use of decision-support tools. Capacity-building efforts centred on training, tools, and technical assistance, with minimal use of incentives. Implementation outcomes were primarily measured at the patient or facility level, whereas sustainability was rarely assessed. Few studies examined links between technical package implementation and national NCD action plans or monitoring frameworks. Despite growing uptake of WHO technical packages in LMICs, implementation science remains underutilized and applied inconsistently. Limited use of formal frameworks, weak integration with national policy processes, and scarce assessment of sustainability constrain the implementation and adaptation of these packages to deliver long-term impact. Strengthening structured implementation approaches, investing in research and system capacity, and embedding implementation science within policy cycles are critical to accelerating and sustaining progress on NCDs in LMICs.