Chhabra Shakuntala 

Mahatma Gandhi Institute Of Medical Science Sewagram Wardha Maharashtra, India

Globally environment and climate change are burning issues. Disposable plastic in health care is a big contributor, because the scale of use is alarming. Growth of single-use devices rather than reusable medical products is largely driven by concerns of infection from contaminated medical equipments , convenience and may be some hidden agenda. Irresponsible disposal of used plastic leads to buildup of litter, supporting foul environment, harming everything on earth, including water . Proportion of medical plastics disposed by different means vary with facilities available in healthcare units of regions, countries, knowledge and attitude of staff. Substantial evidence does exist about attempts at reduction of plastic use. In studies patients were willing to compromise by using reusable itoms for more sustainable healthcare, food for researchers, policymakers, citizens, other stakeholders. Empowering, educating communities to act collectively to minimize plastic pollution and find alternative options must be enforced. Plastic pollution is global concern, that must be addressed collectively. Change in plastic base material, its use, management of plastic waste , recycling are challenging including challenge of opportunities of converting plastic waste into industrial feedstock . ‘UBUNTU ‘ ‘I am because of you’ will be ‘UTNUBU ‘we will not be there’ , if plastic use continues with same pace .U turn is essential with some stars of newer knowledge, technology added

Omar Alhussaini 

Freelance, Oman

Many friends and colleagues call me “the global citizen” I prefer Sinbad (as the myth says he was born in Sohar-Oman then moved to Baghdad-Iraq) as I am Omani from Iraqi origin, and that is my journey in health professional education (for more than 50 years).

Lived in different parts of the world, at different stages of my life, exposed to different societies and communities, understood medicine is more than a science or subject, influenced by my parents (both doctors), learned more about mis-habits in the clinical practice and medical education.

Studied medicine in Irbid-Jordan and learnt a lot from the community and practices in medicine (we worked as interns as well as medical students) then moved to Oman, worked in primary, secondary and tertiary health institutes, being part of establishing medical education unit then department in Sultan Qaboos University and introduced OSCE (it proper way) with all the struggles and obstacles. Not to forget my experience in medical education in Dundee, CME nothing more than to say than it is really the (Discovery city) where I learnt to discover more about Medical education and it is influence on my practice as a clinician and educationalist.

My maturity, understanding of life, the role of the community to hone my attitude and engagement in medical education and practice, will share all these experiences with my colleagues in different parts of the world and different health professionals.

Harini Aiyer, Erin Walling, Robert Woollard

University of Saskatchewan, Canada

The Community Triad Model (CTM) elucidates the interconnectedness between community, students, faculty and the broader institution, and the pathways through with community-based placements directly and indirectly influence decision-making in institutions. Strengthening these relationships involve rebalancing power between the community and medical institution, as well as between students and faculty. 

This study initially began by exploring the relationship between the three arms of the community triad by examining the literature on community placements and Social Accountability (SA), revisiting popular models in SA, as well as inspecting foundational SA reports for expectations around authentic community engagement. While there is an abundance of literature demonstrating the impact of community placements on students, there are limited studies describing the influence of communities on faculty and the broader institution either directly, or indirectly via students. 

The CTM is an operational model of SA that is easy to adopt and implement and can demonstrate how the components of the triad (students, faculty/leadership, community) function together in the community engagement and social accountability of medical schools.

A TUFH talk on the topic will present administrators, leadership, and faculty with an opportunity to explore how they can mindfully construct feedback channels at their institution through which students and faculty (who are already engaging with community) can relay the needs of the communities back to institutions. It will offer students a platform to share their experiences with championing culture change within institutions.

Anne Andermann

McGill University, Canada

With the growing number of transnational threats to our common future and well-being ranging from pandemics and climate change to AI and political unrest, understanding how to prevent disruptions and prevent health problems is becoming more urgent. We all value healthy and safe societies, but how is this achieved? Health promotion founded on the principles of the Ottawa Charter is an essential approach to building healthy public policies and creating supportive social and built environments for health to ensure our collective health. As a public health physician and policy expert with almost 2 decades working across health systems and government, Dr Andermann will outline a potentially powerful approach to overcoming the bottleneck that currently exists in moving scientific evidence into policy which can have far-reaching opportunities for creating healthier and more resilient societies. Building on existing examples of collaborative work between schools of public health and of public policy in a variety of country contexts such as the USA, UK, Singapore and China, Dr Andermann will propose a vision for a way forward to work better together as the stewards of systems and structures that are critical to producing healthier and safer societies, which would likely be a cost-effective alternative to the current crisis of overburdened health systems and an overworked health workforce.

Mohammed Ishaaq Datay

University of Cape Town, South Africa

South Africa has a legacy of Apartheid, and in Cape Town the effect of Apartheid engineering cannot be starker, with it being classified as one of the most unequal cities in the world. Despite being 30 years post democracy, in underprivileged communities, the levels of crime, unemployment, teenage pregnancy, school dropout, drug use and gangsterism in certain areas have only increased, and food security becoming a more prevalent issue. By comparison, some privileged communities in Cape Town are exceptionally wealthy, with thriving economies boasting property prices rate among the highest in the country.

These structural barriers are entrenched through minimal interaction between people of different geographic, social and economic classes resulting in an intergenerational perpetuation of cycles of poverty. It is said that one becomes the company one keeps and if that company is “gangsters” we are more likely to follow that route, whereas if spends time with a professional, an entrepeneur, an artist or any other vocation, one is more likely to follow that path. 

I am a practicing Medical doctor teaching Health Promotion and will speak about we are facilitating Ubuntu engagements in different communities. The premise is through dedicating at least 1 Ubuntu hour per week, over a sustained period of time, connecting people of privileged and underprivileged backgrounds, we are able to share ideas and skills across different pockets of society. Already, through minimal effort we are starting to see potentially impactful effects. 

These engagements incorporate “Moses Longitudinal Life course Model” and Primary Health Care Principles, Health Promotion Behavior change principles. Through a commitment to a longitudinal approach the idea is to guide and uplift of a new generation of leaders who will work together towards the creation of an Ubuntu Society.

Heidi Berhoud

Heidi Berthoud Consulting, United States of America

Community Health Assessments (CHA) are an important tool for rural health departments to better understand community health needs, gaps, and identify opportunities to build on existing strengths. In the U.S. many CHAs only use quantitative data and don’t thoughtfully or intentionally engage community voices in their approach.

To ensure the community is represented in the CHA, we engage diverse voices in rural and remote regions in the Pacific Northwest of the U.S. to help health departments hear directly from community members about their most important health needs. We use qualitative methods in two languages to engage local voices in the CHA process. We share our data back with the community in beautiful and creative ways. Our findings have helped rural health departments identify key health needs and concerns and elevate voices that may not otherwise be included.

By listening to the community, we learn valuable information about local health needs, gaps, and existing strengths that may not have been immediately evident via analysis of quantitative data alone. Through qualitative data collection and analysis methods, we gain a much more comprehensive picture of community health needs and public health departments are better positioned to implement high quality health planning and programming. Rural health departments should prioritize qualitative data collection and community storytelling activities in multiple languages to better understand the most pressing health needs in their community. 

Why This Will be a Great TUFH Talk

This talk will be delivered in a storytelling style, which makes it a great fit for an Ubuntu Talk. Collecting and sharing community data is an important part of improving public health and health care delivery and this talk will highlight how we engage with communities, and how we share their stories.

Barb Doty

Alaska WWAMI University of Washington School of Medicine, United States of America

The US General’s 2023 Advisory raises alarm about the adverse health effects of Social Isolation and the importance of Connection to Community. for overall health. Significant adverse health outcomes have been attributed to social isolation, exacerbated by the Covid 19 pandemic and compounded in northern climates by long harsh winters and the staunch independence of Alaska’s peoples.

The community of Wasilla, Alaska took this health concern seriously, and launched an intervention in partnership with an award-winning New York-based designer, Ayse Birsel, to “Design the Long Life You Love” using community gatherings to share design principles and explore their applications to life and community planning for older Alaskan healthy lifestyles. 

Wasilla, Alaska’s senior leadership organized to present a series of training sessions to guide participants, using the power of design principles rooted in optimism, empathy and collaboration in a creative process to reshape community engagement. Sessions facilitated exploration of community needs and individual interests and provided tools to translate these concepts into actionable goals for both individuals and enduring resources for the community. Trainers were enlisted and developed to carry on community engagement activities into the future with planned annual design sessions to encourage viability of projects over time.

The organizers hope to successfully engage older Alaskans in becoming a vibrant part of the community fabric and to identify creative ways to become connected and socially engaged while making significant contributions to the wellbeing of their community members.

Ayat Abu-Agla

Health System Research Centre Dubai. University of Birmingham Dubai, Sudan

In an era of polycrises, the COVID-19 pandemic has drawn attention to how chronic underinvestment in our health systems compromises human health and leads to serious economic and social setbacks. We have witnessed the eastern Mediterranean and African regions most vulnerable countries falling further behind, as they lack the fiscal space to make the necessary investments in the human resources for health to build more resilient health systems. Furthermore, deeply influenced by the geographies of power and recognizing the disparities in decision-making, countries in these regions are being tasked to restructure, transform, and upgrade health systems and their health workforce to meet the needs of universal healthcare coverage (UHC) and sustainable development goals (SDG) to ensure health security. In such geopolitical climate, there is pressing need to review the nature of health systems in terms of their role and mission and high time to re-think how we teach, train, or build capacities in health systems as well as why we teach the way we do while realising the need to decolonise global health, knowledge production and utilization. The session will highlight experiences of field building and reflections on the HPSR competencies required to support and strengthen reflexive, ‘learning health systems’; and decolonizing health policy and systems teaching and learning strategies, including pre-professional, continuing professional education that actively reflect on knowledge production and use for just health systems, including the regional health system research agenda; the need for building capacities across institutions, systems and networks for context and cultural appropriate application during emergency response and everyday resilience.

Caroline Phegan, Paul Worley, Amy Mendham, Kate Bartel, Carolyn Martin, Nick Georges, Emily Mathews, Kerry Dix, Jane Fuller, Elise Hutley, Wayne Champion

Riverland Academy Clinical Excellence, Australia

Having a relevant evidence base for care is essential for all health services, but the best evidence may be different in different contexts. Historically in Australia, if engaged in research at all, small rural health services have been used to provide sites for research initiated and led by tertiary metropolitan research groups. there has been very little translation of this research into rural health care.

This has now changed in the Riverland region of Australia. With the formation of the Riverland Academy of Clinical Excellence, the Riverland Mallee Coorong Local Health Service has created its own Research Unit and Public Health Unit, with the explicit goals of collaboratively building local research capacity to drive and measure improvement in outcomes for local rural communities.

This investment has resulted in the employment of three PhD qualified researchers to support local clinicians in their research, the recruitment a qualified Public Health Physician to work with other MPH qualified local clinicians, the employment of a dedicated Research Officer to build better research governance, and the development of a value-based care population health framework to evaluate the impact of the local health service over time.

The Academy has increased the local audit activity in the health service, partnered with local universities to lead nationally funded research in its priority areas of diabetes, mental health, medical education and artificial intelligence, created Grand Rounds and Journal Clubs, increased clinical trials access for local patients, and been asked to contribute to innovation and research translation policy at a State and national level.

This presentation provides the rationale, policy and organisational frameworks developed, and lessons learned by the Research and Population Health Units.

Yvonne Mongare

University of Minnesota, United States of America

There are numerous systems within our society that predetermine the health and well-being outcomes of communities, whether they are urban, suburban, or rural. While some communities may benefit from these systems, others are disproportionately affected. Many diseases are exacerbated by social determinants of health, particularly extreme weather events, lack of social support within communities, limited educational access and quality, and low health literacy. Challenging these entrenched systems is imperative to transition from a local perspective to a global initiative for improved health outcomes.

The prevailing concept of healthcare must be critically examined by restructuring the existing systems that hinder the quality of life for certain individuals. Healthcare professionals possess unique capabilities to redefine the narrative surrounding healthcare worldwide. Educational systems play a crucial role in assisting individuals who may struggle to comprehend the intricacies of their healthcare plans.

Efforts should be made to enhance transportation accessibility to and from clinics, particularly for those residing in urban or rural areas where transportation options are limited. Additionally, promoting telehealth services and providing translators for patients in need of support from their homes can bridge existing gaps in healthcare accessibility. 

Societal transformations are necessary to ensure that healthcare is universally accessible and facilitates a supportive process for all individuals. When local communities are empowered to access the healthcare services they require, it fosters incentive to changes at the national and global levels. Ultimately, reshaping the framework of healthcare has the potential to alleviate burdens and promote overall well-being.

Jason Curran, Alan Ruddiman, Leslie Carty

Rural Coordination Centre of BC (RCCbc), Canada

This Ubuntu Talk focuses on the concept and real-world application of small “r” rESEARCH – applied and locally focused research designed to expeditiously inform health policy and accelerate the implementation of innovative solutions into the rural context.

In addition to funding embedded staff within the research departments of regional health authorities in British Columbia (BC), Canada, the Rural Coordination Centre of BC (RCCbc) facilitates networking and research through:

– Biannual funding competitions for a Rural Physician Research Grant program and a Rural Global Health Partnership Initiative that builds capacity in rural and remote evidence generation.

– An annual showcase of ongoing rural research in BC through an RCCbc-initiated annual virtual Knowledge Exchange.

The resulting emphasis on supporting rural research:

– Builds mentorship and recruitment opportunities for regional medical students to explore rural practice, investigate rurally focused issues, and network with practicing rural physicians in the province.

– Generates meaningful data that effectively informs regional policy and validates the feasibility and safety of local health innovations.

– Develops strategic partnerships with health decision-makers focused on the provision of rural health services in BC.

The talk will conclude with two recently published, peer-reviewed studies funded by the RCCbc that highlight the colossal role rural rESEARCH can have on enhancing patient safety, building equity for rural health, and exploring innovative solutions to complex problems. These studies include:

– An evaluation of delays for emergent CT scans from a rural British Columbia hospital.

– A feasibility study of patient-controlled analgesia (PCA) for rural and remote transfers

Suneel Parvatheddy

Atrium Health Wake Forest Baptist/ Advocate Health, United States of America

Background:
About 43% of the population live in rural areas globally with limited to no access to health care. Multiple barriers such as geographical location, transportation, inclement weather conditions, low literacy rate, unemployment, aging population, lack of financial resources lead to limited preventive care access and almost no access to specialty care services. As such there is a high incidence of unhealthy behaviors and poor life style choices among the rural population leading to high-risk health related problems associated with alcohol, tobacco, and substance abuse.
Purpose:
This study aims at reviewing the latest innovations in care delivery models and modern health information systems to help reduce the disparities between urban and rural health care around the world.
Methods:
A literature search was done to identify innovative care models and novel health care initiatives around the world which had positive outcomes during the COVID pandemic with special focus on telehealth, virtual health, hospital at home, mobile clinics, uber health, health information systems, utilization of AI, innovative staffing ideas, etc. and discuss their impact and relevance in rural settings.
Conclusion:
There were numerous health innovations and latest technology advancements that were deployed during COVID pandemic. This study identified that appropriate utilization of those resources in rural areas globally could offer a permanent solution in reducing the care gaps and improve the overall outcomes when compared to their urban counterparts.

Kim Williams, John Pawlovich

Rural Coordination Centre of BC, Canada

Healthcare providers in British Columbia’s rural, remote, and First Nations communities experience different challenges in providing patient care than their urban counterparts. We will show the importance of relationships and partnership in building and delivering peer to peer virtual care in rural and remote communities across British Columbia, Canada. The Pentagram Partnership Plus social accountability framework has been foundational in establishing relational foundation for the work.
Real Time Virtual Support (RTVS) peer pathways help ensure that rural healthcare providers are properly supported and rural patients receive more equitable access to healthcare. More specifically, RTVS pathways:
– Establish collegial relationships between RTVS virtual providers and rural healthcare providers to facilitate team-based patient care and build a stronger community of practice.
– Increase confidence, and reduce isolation, of healthcare providers who provide patient care in rural, remote, and First Nations communities in British Columbia.
– Increase mentoring and educational opportunities for rural healthcare providers—especially new-to-practice physician residents.
– Improve the recruitment and retention of rural healthcare providers.
– Increase availability and access to timely, quality healthcare services for patients in rural, remote, and First Nations communities, reducing their risk, time, and expense traveling for medical appointments.
Offer a cost-effective and sustainable model for British Columbia’s health system needs.

Richard Colbran, Robyn Ramsden

NSW Rural Doctors Network, Australia

Background
Not-for-profit (NFP) health organisations are recognised by the World Health Organisation (WHO) for providing non-hospital and maintenance-care services across many health disciplines, often relieving governments of workload and tackling wicked problems. Despite their noble intent, their effectiveness and viability are today questioned as stakeholders seek stronger return on investment and organisational accountability. Can organisational performance measurement (OPM) help NFPs address this challenge?
At TUFH 2022, preliminary findings of research aiming to understand perspectives of organisational performance of health NFPs were presented. The outcome of that research is now available.
Methods
Between 2014 and 2019 an ethics approved body of mixed methods research was conducted. The research plan involved five independent, yet interconnected, studies relating to organisational performance measurement (OPM) in health NFPs. The studies included narrative and systematic literature reviews, model design and case study testing.
Results
This study found that OPM is a recognised evidence-based business approach that enhances the effectiveness and sustainability of organisations, and that OPM is under-utilised by health NFPs. The study also found that adapting OPM measures to the NFP’s strategic purpose enhances OPM implementation success but that there were no published OPM implementation models, frameworks or tools nuanced for the specificities of health NFPs.
Utilising the evidence sourced by the study, the authors created the Measurement Advantage Implementation Model (MAIM) for health NFPs.
Conclusions
MAIM provides a comprehensive, easy-to-use, evidence informed OPM implementation tool where none has previously existed. MAIM is now available for health NFPs seeking to improve their performance, impact and sustainability.

Vasundhara Rangaswamy

Association for India’s Development, India

In a country like India, all kinds of practices and practitioners have made in-roads in rural and remote areas due to deprivation of care facilities, lack of regulation and poor literacy. The country has over a million unregistered practitioners many who provide irrational injections and drips at one’s doorstep, a variety of medicines are available over the counter and being the pharmacy capital of the world, the maximum production and sales of irrational fixed dose combination antibiotics and other drugs also happens here. Inappropriate prescription, practice and consumption are a constant threat. There can be a marked difference between what is taught in medical education and what is prescribed or between what is prescribed to what is popped in! The consequences range from delays in access to appropriate care, increase in out of pocket expenditure, fueling the antimicrobial resistance pandemic while filling coffers of pharma giants and of doctors engaged in ‘cut-practice’ and to even influencing country’s elections! A powerful collective voice from the ground is needed to fight these numerous challenges. This is possible if the community is engaged and informed.

With another public health physician, I coordinate a multi state rural community health program touching 50,000 people. In this we engage with health workers picked from the community and also directly with the communities. Besides practical skill training, we share information on commonly encountered biomedical conditions, on social determinants and their relation to health, on how the government health system works and how to hold it accountable and also on drug literacy. The program is in its infancy however we have begun to see some positive practice changes in our health workers already. We hope to see a wave of change by a ripple effect!

Wayne Champion, Paul Worley, Caroline Phegan, Tania Vanderpeer, Sharon Harrison, Sharon Wingard, Hamish Eske, Karen Hollitt, Brad Birleson, Sharon Frahn

Riverland Mallee Coorong Local Health Network, Australia

Historically, the Riverland region of South Australia has outsourced the production of its most vital health resource – it’s health workforce. This resulted in crisis after crisis. With the formation of the Riverland Academy of Clinical Excellence, this has now changed.

In three years we have increased our medical workforce by 25% by creating an employed post-graduate training program for local graduates, commenced early career nurse education, and partnered with Flinders University to deliver full allied health university programs locally. We are moving towards a locally-led rather than locum-led health service. The Academy’s strategy is based on evidence-based workforce and education principles and policies.

This short talk outlines the lesson learned and the principles that can be applied in other small rural health services to achieve profound improvements in their health workforce.  

Oliver Hurley

Memorial University of Newfoundland, Canada

In recent years, there has been a notable surge in visits to the Emergency Department (ED) by older adults, particularly those aged 65 and above. Often, these older adults arrive at the ED without an apparent acute medical reason for their visit and find themselves unable to return home. This demographic may be termed ‘social admissions,’ ‘failure to cope/thrive,’ ‘community emergencies’ (CEs), or other local colloquialisms, reflecting varying hospital policies, cultures, or media influences. Despite the lack of a standardized term, these patients consistently pose a significant burden on the workflow of rural emergency departments. 

For these older adults, the ED becomes the ‘final common pathway.’ Yet, community-based healthcare professionals lack the necessary resources, collaborative networks, and organizational infrastructure to offer comprehensive medical, social, and functional support beyond the hospital setting. Consequently, the management of CEs remains diverse, with questionable efficacy for optimal patient outcomes, and lacks clarity both in Canada and within medical literature. 

Ideally, alternative care pathways should be available outside the hospital setting to address the needs of this demographic. However, healthcare systems have not adequately adjusted to demographic shifts and increased healthcare demands. How do we effectively care for these patients? What interventions are specifically required? What approaches are rural EDs currently employing to address this issue? 

With over two decades of experience in rural family and emergency medicine, along with co-authoring publications on this topic, my involvement in community-based research initiatives has led to a deep understanding of the challenges encountered by rural healthcare systems in handling CEs. The topic is well-suited for an Ubuntu Talks session as it addresses a pressing issue faced by rural healthcare systems, offering valuable insights and actionable recommendations within the limited timeframe provided.

Sairu Philip

Government Medical College Kottayam, India

It is regarding experiential learning of community based palliative care by students of a medical college by regular visits for home care to bedridden patients. This helped to ignite their thinking regarding needs of the patients and their actions towards meeting their needs. The real world needs of patients incited students to collectively to involve in solving the short term problems of the patients. In the process the students get attached to around 30 families of bedridden patients. The students go to their homes regularly and once in a year all 30 families meet in the medical college and spend one day sharing experiences entertaining each other. They continued this kinship even during covid lock down period exhibiting empathy to the needs of patients eg. collecting money for securing a land deed which was given for loan purpose, bringing a person differently abled to the campus to view football matches.

This program which started in 2009 continues even in 2024 with each new batch taking up the responsibilities of these patients.

Why it would be a great TUFH talk?

Exposing medical students to real needs of society can bring out problem solving actions innate in them. Facilitating this process helps in developing empathy and insight to needs of persons with long term illness marginalised in the community. This should inspire educators to include community based experiential learning methods for developing competencies and skills and social accountability.

Richard Colbran, Ray Markham, Anne Lesack, Yann Guisard, Robyn Ramsden, Dan Harper

Rural Coordination Centre of BC; Rural Doctors Network, Canada

The annual TUFH Conference acts as a fertile ground on which partnerships, collaborations, and solutions that support global health equity can grow. The 2022 TUFH Conference held in Vancouver, Canada acted as a catalyst for the relationship between the Canadian, Rural Coordination Centre of British Columbia (RCCbc), and the Australian, Rural Doctors Network (RDN). 

Over the last 2 years, a partnership has grown due to our organization’s shared foundation in socially accountable networks, and mission of enhancing rural health care equity. We recognize in working together, we can further advance our individual and collective goals for the continued growth and sustainability of rural health systems, infrastructure, and workforce. 

While strong partnership building takes time and commitment, in working together we benefit from each other’s experience and can build upon our established strengths to build and maintain successful long term and measurable impact across diverse contexts. 

In this Ubuntu talk, leaders from both RDN and RCCbc will speak together on the importance of partnerships in enhancing healthcare outcomes. The talk will inspire participants to think about the partnerships available within their global network and how they can develop them for collective impact.

Peter Adams, Saria Hassan, Cruz Nazario, Rohan Maharaj, Maxine Nunez, Marcella Nunez-Smith

The University of the West indies, Cave Hill Campus

Background: The Caribbean lacks tailored and scalable evidence-based diabetes prevention initiatives despite having the highest diabetes prevalence in the Americas. The Lifestyle Intervention with Metformin Escalation implementation study (LIME) aimed to reduce diabetes incidence among persons with prediabetes in Barbados, Puerto Rico, Trinidad and Tobago, and the US Virgin Islands through lifestyle workshops and metformin medication. We worked with key stakeholders across four Caribbean islands to adapt the existing Help Educate to Eliminate Diabetes (HEED) evidence-based lifestyle workshops to local conditions.

Methods: Ten stakeholders drawn from civil society, faith-based organizations, policy makers, and people living with diabetes were engaged in four virtual meetings. They helped adapt the workshop programme to local conditions through a structured process leveraging regional knowledge to ensure the appropriateness for the cultural context.

Results: Adaptations included reducing the number but increasing workshop duration, increased time to discuss emotional well-being in islands with recent hurricanes, using food examples based on the cuisine of each island, framing how body image and weight loss were discussed, creating WhatsApp groups and a customized iHEEDapp listing local resources to help sustain change and having clinic personnel in addition to only peer leaders deliver workshops to ensure sustainability beyond the study period.

Discussion: The LIME Study provides a concrete example of the strong potential of regional stakeholder engagement to leverage similarities and inform implementation of chronic disease prevention across a multicultural region.

Conclusion: This combination of multi-stakeholder collaboration is a model that should be employed in other regions of the world.